Author + information
- Received October 15, 2001
- Revision received May 30, 2002
- Accepted July 2, 2002
- Published online October 2, 2002.
- Lisa A Freed, MD, FACC*,†,‡,
- Emelia J Benjamin, MD, ScM, FACC*,§∥,
- Daniel Levy, MD, FACC*,‡∥,¶,#,
- Martin G Larson, ScD*,∥,
- Jane C Evans, DSc*,∥,
- Deborah L Fuller, RDCS*,
- Birgitta Lehman, RDCS* and
- Robert A Levine, MD, FACC†,‡,* ()
- ↵*Reprint requests and correspondence:
Dr. Robert A. Levine, Massachusetts General Hospital, Cardiac Ultrasound Laboratory, 55 Fruit Street-VBK 508, Boston, Massachusetts 02114, USA.
Objectives The aim of this study was to examine the echocardiographic features and associations of mitral valve prolapse (MVP) diagnosed by current two-dimensional echocardiographic criteria in an unselected outpatient sample.
Background Previous studies of patients with MVP have emphasized the frequent occurrence of echocardiographic abnormalities such as significant mitral regurgitation (MR) and left atrial (LA) enlargement that are associated with clinical complications. These studies, however, have been limited by the use of hospital-based or referral series.
Methods We quantitatively studied all 150 subjects with possible MVP by echocardiography and 150 age- and gender-matched subjects without MVP from the 3,491 subjects in the Framingham Heart Study. Based on leaflet morphology, subjects were classified as having classic (n = 46), nonclassic (n = 37), or no MVP.
Results Leaflet length, MR degree, and LA and left ventricular size were significantly but mildly increased in MVP (p < 0.0001 to 0.004), with mean values typically within normal range. Average MR jet area was 15.1 ± 1.4% (mild) in classic MVP and 8.9 ± 1.5% (trace) in nonclassic MVP; MR was severe in only 3 of 46 (6.5%) subjects with classic MVP, and LA volume was increased in only 8.7% of those with classic MVP and 2.7% of those with nonclassic MVP.
Conclusions Although the echocardiographic characteristics of subjects with MVP in the Framingham Heart Study differ from those without MVP, they display a far more benign profile of associated valvular, atrial, and ventricular abnormalities than previously reported in hospital- or referral-based series. Therefore, these findings may influence the perception of and approach to the outpatient with MVP.
☆ This work was supported by NIH/NHLBI contract N01-HC-38038, NIH/NINDS 5-R01-NS-17950-16, by NIH grants HL38176, HL53702, K24 HL67434, by the Doris Duke Charitable Foundation, and by the Roman W. DeSanctis Clinical Scholar Fund. We gratefully acknowledge the Hewlett-Packard Foundation Grant for upgrading our Hewlett Packard Ultrasound system to Sonos 1000 (Andover, Massachusetts).
- Received October 15, 2001.
- Revision received May 30, 2002.
- Accepted July 2, 2002.
- American College of Cardiology Foundation