Related Experiment Videos
Complications of mitral valve prolapse. Disproportionate occurrence in men and older patients
Abstract:
To determine factors influencing the strength of association between mitral valve prolapse and mitral regurgitation, ruptured chordae tendineae, and infective endocarditis, the prevalence of mitral prolapse in patients with disease was compared with both clinical and population control groups. The prevalence of mitral valve prolapse was 4 percent among population and clinical control groups (eight of 196 and 84 of 2,146, respectively) and was significantly higher (p less than 0.001) in patients with endocarditis (11 of 67, 16 percent), mitral regurgitation (17 of 31, 55 percent, and ruptured chordae (27 of 43, 63 percent). Odds ratios for complications in persons with mitral valve prolapse ranged from 4.6 for endocarditis to 41.4 for ruptured chordae in overall analyses, and from 6.8 for endocarditis to 53.0 for ruptured chordae based on age- and sex-matched case-control triplets (p less than 0.001 for each). All complications occurred disproportionately in men with mitral valve prolapse, in whom odds ratios ranged from 2.5 to 7.4 compared with an additional control group of unselected subjects with mitral valve prolapse. Compared with this control group, patients with mitral valve prolapse and endocarditis were slightly more likely to have a previously known heart murmur (odds ratio 3.2, difference not significant) but significantly more likely to have murmurs at the time of evaluation (odds ratio 8.5, p less than 0.01). Patients with mitral valve prolapse and mitral regurgitation and ruptured chordae tendineae were also significantly older than the unselected subjects with mitral valve prolapse (48 +/- 14 and 55 +/- 16 versus 38 +/- 14 years, p less than 0.005 for both). The concentration of risk of endocarditis in men with mitral valve prolapse and patients with antecedent murmur suggests that antibiotic prophylaxis is warranted in these groups but not in women without a murmur of mitral regurgitation.
Insights
Mitral valve prolapse significantly increases risks for endocarditis, mitral regurgitation, and ruptured chordae tendineae, especially in men. Antibiotic prophylaxis is recommended for men with mitral valve prolapse and murmurs.
Area of Science:
- Cardiology
- Valvular Heart Disease
- Epidemiology
Background:
- Mitral valve prolapse (MVP) is a common valvular heart condition.
- The association between MVP and its complications like mitral regurgitation (MR), ruptured chordae tendineae (RCT), and infective endocarditis (IE) requires further investigation.
- Understanding risk factors can guide clinical management and prophylaxis strategies.
Purpose of the Study:
- To determine factors influencing the strength of association between mitral valve prolapse and its complications.
- To compare the prevalence of MVP in patients with MR, RCT, and IE against control groups.
- To identify specific patient subgroups at higher risk for these complications.
Main Methods:
- A case-control study comparing the prevalence of MVP in patients with MR, RCT, and IE.
- Control groups included both population-based and clinical cohorts.
- Odds ratios were calculated for complications in individuals with MVP, including age- and sex-matched analyses and comparisons with an unselected MVP control group.
Main Results:
- MVP prevalence was significantly higher in patients with endocarditis (16%), mitral regurgitation (55%), and ruptured chordae (63%) compared to controls (4%).
- Odds ratios for complications in MVP patients ranged from 4.6 (endocarditis) to 41.4 (ruptured chordae).
- Men with MVP had disproportionately higher risks for all complications. Patients with MVP and endocarditis were more likely to have murmurs, while those with MVP, MR, and RCT were older than the general MVP population.
Conclusions:
- Mitral valve prolapse is strongly associated with increased risks of mitral regurgitation, ruptured chordae tendineae, and infective endocarditis.
- Men with MVP and patients with antecedent murmurs are at particularly high risk for endocarditis.
- Antibiotic prophylaxis is warranted for men with MVP and those with a murmur, but not for women without MR.