Early Right Heart Remodeling in Patients With Mitral Valve Prolapse

Mitral valve prolapse (MVP) has been associated with left heart remodeling. This study explored cardiac remodeling in patients with MVP without significant regurgitation, focusing on the right heart.

This single-center study enrolled consecutive patients referred to trans-thoracic-echocardiography (TTE) with MVP, excluding those with significant regurgitation or known cardiovascular or pulmonary diseases. A group of healthy controls was included.

Forty-nine patients with MVP and 54 controls were finally selected (mean age of 62, 52-71; 52% males), and echocardiographic parameters were compared among groups. Twenty-nine (41%) patients with MVP showed tricuspid valve prolapse (TVP). Patients with MVP, irrespective of TVP, showed greater tricuspid annulus (systolic annulus: 31±6 vs. 32±5 vs. 27±3 mm for MVP⁺/TVP^-, MVP⁺/TVP⁺, and controls, respectively; all p < 0.01) and greater minimum right atrial volume indexed (13, 12-15 mL/m² vs. 15, 12-20 mL/m² vs. 11, 10-14 mL/m²; all p < 0.05). Right ventricular dimensions and systolic indexes did not differ among groups, except TAPSE, which was significantly greater in MVP⁺/TVP⁺ patients compared to controls (25±4 vs. 22±3 mm, p = 0.004). A significant correlation (ρ = 0.43; p < 0.001) and an independent association at multivariate analysis (ß = 0.28; 95% CI 0.09-0.47; p = 0.004) were observed between end-systolic tricuspid diameter and TAPSE.

In patients with MVP with less-than-moderate mitral or tricuspid regurgitation, dilation of the right atrium and tricuspid annulus was found. The latter finding was associated with increased values of TAPSE, which should then be used with caution, while other indexes may be preferred when assessing the systolic function of these patients.