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Predisposing factors for severe mitral regurgitation in idiopathic mitral valve prolapse
1Second Department of Internal Medicine, School of Medicine, University of Tokushima, Japan.
Abstract:
To elucidate predisposing factors for severe mitral regurgitation (MR) in idiopathic mitral valve prolapse (MVP), 124 MVP patients were classified into the following categories: 55 with isolated clicks (click group), 35 with a late-systolic murmur (late-SM group), and 34 with a holosystolic murmur (holo-SM group). Their clinical and echocardiographic findings were compared with those of 26 patients with spontaneous chordal rupture (rupture group). In 22 patients in the click group, 24 in the late-SM group, and 22 in the holo-SM group, follow-up studies were performed for a mean of 4.5 years (range 1 to 13.5). The mean age was youngest in the click group and oldest in the rupture group. The click and late-SM groups showed a female predominance, but the holo-SM and rupture groups showed a male predominance. There was no difference in the incidence of systemic hypertension among the 4 groups. Most patients in the click and late-SM groups had anterior leaflet prolapse. In the holo-SM and rupture groups, however, the incidence of posterior leaflet involvement was significantly increased. The incidence of thickened mitral valve increased in order of the click (8%), late-SM (21%), holo-SM (38%), and rupture (50%) groups. Six patients in the holo-SM group developed chordal rupture with severe MR during the follow-up period. In the click and late-SM groups, however, there were no complications and no development into a holo-SM. Thus, aging, male sex, posterior leaflet prolapse, thickened mitral valve, and holo-SM were found to be important predisposing factors for severe MR in idiopathic MVP.
Insights
Idiopathic mitral valve prolapse (MVP) can lead to severe mitral regurgitation (MR). Key risk factors for severe MR include older age, male sex, posterior leaflet prolapse, and thickened mitral valves, particularly in patients with holosystolic murmurs.
Area of Science:
- Cardiology
- Valvular Heart Disease
- Echocardiography
Background:
- Idiopathic mitral valve prolapse (MVP) is a common valvular heart condition.
- Severe mitral regurgitation (MR) is a potential complication of MVP.
- Identifying predisposing factors for severe MR in MVP is crucial for patient management.
Purpose of the Study:
- To elucidate predisposing factors for severe mitral regurgitation (MR) in patients with idiopathic mitral valve prolapse (MVP).
Main Methods:
- 124 MVP patients were classified into isolated clicks, late-systolic murmur (late-SM), and holosystolic murmur (holo-SM) groups.
- Clinical and echocardiographic findings were compared with a group of patients with spontaneous chordal rupture.
- Follow-up studies were performed for a mean of 4.5 years.
Main Results:
- Older age, male sex, posterior leaflet prolapse, and thickened mitral valve were more prevalent in patients who developed severe MR or chordal rupture.
- The incidence of thickened mitral valve increased progressively from the click group to the rupture group.
- Six patients in the holo-SM group developed chordal rupture with severe MR; no complications occurred in the click or late-SM groups.
Conclusions:
- Aging, male sex, posterior leaflet prolapse, thickened mitral valve, and holosystolic murmur are significant predisposing factors for severe MR in idiopathic MVP.
- Early identification of these factors can aid in risk stratification and monitoring of MVP patients.