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Published on: May 19, 2020
Severe mitral regurgitation due to mitral valve prolapse: risk factors for development, progression, and need for
R G Singh1, R Cappucci, R Kramer-Fox
1Department of Medicine, The New York Presbyterian Hospital-Weill Medical College of Cornell University, New York 10021, USA.
Abstract:
Patients with mitral valve prolapse (MVP) may develop severe mitral regurgitation (MR) and require valve surgery. Preliminary data suggest that high body weight and blood pressure might add to the irreversible factors of older age and male gender in increasing risk of these complications. Fifty-four patients with severe MR due to MVP were compared with 117 control subjects with uncomplicated MVP to elucidate factors independently associated with severe MR: the need for valve surgery and the cumulative risk of requiring mitral valve surgery. Patients with severe MR were older (p<0.00005), more overweight (p = 0.002), had higher systolic (p = 0.0003) and diastolic (p = 0.007) blood pressures, and were more likely to have hypertension (p = 0.0001) and to be men (p<0.001). In both groups, men had higher blood pressure and relative body weight than women. In multivariate analysis, older age was most strongly associated with MR; higher body mass index, hypertension, and gender were independent predictors of severe MR in analyses that excluded age. Among the 54 patients with severe MR, the 32 (59%) who underwent mitral valve surgery during 11 years of follow-up were older, more overweight, and more likely to be hypertensive than those not requiring surgery. Among patients undergoing mitral valve surgery in 3 centers, mitral prolapse was the etiology in 25%, 67% of whom were men. Using these data and national statistics, we estimate that the gender-specific cumulative risk for requiring valvular surgery for severe MR in subjects with MVP is 0.8% in women and 2.6% in men before age 65, and 1.4% and 5.5% by age 75. Thus, subjects with MVP who are older, more overweight, and hypertensive are at greater risk for severe MR and valve surgery. Higher blood pressure and relative weight in men with MVP appear to contribute to the gender difference in risk for severe MR.
Insights
Older age, higher body weight, and hypertension increase the risk of severe mitral regurgitation (MR) and valve surgery in patients with mitral valve prolapse (MVP). Men with MVP face a higher cumulative risk for MR surgery compared to women.
Area of Science:
- Cardiology
- Valvular Heart Disease
- Epidemiology
Background:
- Mitral valve prolapse (MVP) can lead to severe mitral regurgitation (MR), potentially requiring surgical intervention.
- Risk factors for severe MR and subsequent valve surgery in MVP patients are not fully elucidated.
- Preliminary data suggest obesity and hypertension may exacerbate risks associated with age and male gender.
Purpose of the Study:
- To identify independent predictors of severe MR in patients with MVP.
- To determine factors associated with the need for mitral valve surgery.
- To estimate the cumulative risk of requiring valve surgery for severe MR in MVP patients.
Main Methods:
- Comparative analysis of 54 patients with severe MR due to MVP versus 117 controls with uncomplicated MVP.
- Multivariate analysis to identify independent predictors of severe MR.
- Longitudinal follow-up of severe MR patients to assess need for valve surgery.
- Estimation of gender-specific cumulative surgical risks using study data and national statistics.
Main Results:
- Patients with severe MR were older, more overweight, had higher blood pressure, and were more likely to be hypertensive and male.
- Older age was the strongest predictor of MR; higher BMI, hypertension, and male gender were independent predictors when age was excluded.
- Among those with severe MR, 59% required valve surgery, and these patients were older, more overweight, and more likely to be hypertensive.
- Estimated cumulative risk for valve surgery by age 75 was 1.4% for women and 5.5% for men with MVP.
Conclusions:
- Older age, higher body mass index, hypertension, and male gender are significant risk factors for developing severe MR and requiring valve surgery in MVP patients.
- Men with MVP exhibit higher blood pressure and body weight, contributing to their elevated risk for severe MR and surgery.
- Proactive management of weight and blood pressure in MVP patients, particularly men, may be crucial for reducing the risk of severe MR and the need for valve surgery.
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