Author + information
- Received September 21, 1987
- Revision received December 9, 1987
- Accepted December 28, 1987
- Published online May 1, 1988.
- Robert A Levine, MD, FACC∗,a,b,1,
- Evagelos Stathogiannis, MDa,b,
- John B Newella,b,
- Pamela Harrigan, RDMSa,b and
- Arthur E Weyman, MD, FACCa,b
- ↵∗Address for reprints: Robert A. Levine, MD, Cardiac Non-Invasive Laboratory, Phillips House 8, Massachusetts General Hospital, Boston, Massachusetts 02114.
Mitral valve prolapse by current echocardiographic criteria can be diagnosed with surprising frequency in the general population, even when preselected normal subjects are examined. In most or these individuels, however, prolapse is present in the apical four chamber view and absent in roughly perpendicular long-axis views. Previous studies have shown that systolic annular nonplanarity can cause apparent prolapse in the four chamber view without actual leaflet displacement above the most superior points of the anulus, and there is evidence for such nonplanarity in vivo. It is then reasonable to ask whether superior leaflet displacement limited to the four chamber view has any pathologic significance or complications. The purpose of this study, therefore, was to address the following hypothesis: that patients with superior leaflet displacement confined to the four chamber view have no higher frequency of associated echocardiographic abnormalities than do patients without displacement in any view. Such abnormalities, which would provide independent evidence of mitral valve pathology or dysfunction, include leaflet thickening, left atrial enlargement and mitral regurgitation.
Leaflet displacement was measured in the parasternal long-axis and apical four chamber views in 312 patients who were studied retrospectively and selected for the absence of forms of heart disease other than mitral valve prolapse. Eecfiet thickness and left atrial size were measured and mitral regurgitation was grader Patients with leaflet displacement limited to the four chamber view were no more likely to have associated abnormalities than were patients without displacement In any view (0 to 2% prevalence, p > 0.5). In contrast, patients with leaflet displacement in the long-axis view were significantly more likely to have associated abnormalities (12 to 24%, p < 0.005), the frequency of which increased with the extent of leaflet displacement in that view (p < 0.0001). These results suggest that displacement limited to the apical four chamber view is, in general, a normal geometric fading unassociated with echocardiographic evidence of pathologic significance.
↵1 During this work, Dr. Levinc was also a Research Fellow of the Medical Foundation. Inc., Boston.
☆ This study was conducted during the tenure of a Clinician-Scientist Award of the American Heart Association. Dallas, Texas and with funds contributed in part by (he American Heart Association, Massachusetts Affiliate, Inc., Boston, Massachusetts.
☆☆ This study was supported in part by grant R29 HL38176 of Ihe National Institutes of Health, Bethesda, Maryland and by a grant of the American Heart Association, Dallas.
- Received September 21, 1987.
- Revision received December 9, 1987.
- Accepted December 28, 1987.