Severe mitral regurgitation due to mitral valve prolapse: risk factors for development, progression, and need for mitral valve surgery

Singh, Rampaul G; Cappucci, Roger; Kramer-Fox, Randi; Roman, Mary J.; Kligfield, Paul; Borer, Jeffrey S.; Hochreiter, Clare; Isom, O. Wayne; Devereux, Richard B.

doi:10.1016/s0002-9149(99)00645-1

Cited by 47 publications

(30 citation statements)

References 29 publications

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“…Measures to avoid excessive hemodynamic burden such as aggressive treatment for hypertension and overweight may be advisable in some of these patients. 26 With rapid advances in RT3DE technologies, accurate, quantitative analysis of mitral valve morphology by transthoracic RT3DE would become feasible for repeated monitoring and preoperative assessment of mitral valve reparability. February 19, 2013…”

Section: Discussionmentioning

confidence: 99%

Quantitative Analysis of Mitral Valve Morphology in Mitral Valve Prolapse With Real-Time 3-Dimensional Echocardiography

et al. 2013

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Background— Few data exist on the relation of the 3-dimensional morphology of mitral valve and degree of mitral regurgitation (MR) in mitral valve prolapse. Methods and Results— Real-time 3-dimensional transesophageal echocardiography of the mitral valve was acquired in 112 subjects, including 36 patients with mitral valve prolapse and significant MR (≥3+; MR+ group), 32 patients with mitral valve prolapse but no or mild MR (≤2+; MR− group), 12 patients with significant MR resulting from nonprolapse pathologies (nonprolapse group), and 32 control subjects. The 3-dimensional geometry of mitral valve apparatus was measured with dedicated quantification software. Compared with the normal and MR− groups, the MR+ group had more dilated mitral annulus ( P <0.0001), a reduced annular height to commissural width ratio (AHCWR) ( P <0.0001) indicating flattening of annular saddle shape, redundant leaflet surfaces ( P <0.0001), greater leaflet billow volume ( P <0.0001) and billow height ( P <0.0001), longer lengths from papillary muscles to coaptation ( P <0.0001), and more frequent chordal rupture ( P <0.0001). Prevalence of chordal rupture increased progressively with annulus flattening (7% versus 24% versus 42% for AHCWR >20%, 15%–20%, and <15%, respectively; P =0.004). Leaflet billow volume increased exponentially with decreasing AHCWR in patients without chordal rupture ( r 2 =0.66, P <0.0001). MR severity correlated strongly with leaflet billow volume ( r 2 =0.74, P <0.0001) and inversely with AHCWR ( r 2 =0.44, P <0.0001). In contrast, annulus dilatation but not flattening occurred in nonprolapse MR patients. An AHCWR <15% (odds ratio=7.1; P =0.0004) was strongly associated with significant MR in mitral valve prolapse. Conclusion— Flattening of the annular saddle shape is associated with progressive leaflet billowing and increased frequencies of chordal rupture and may be important in the pathogenesis of MR in mitral valve prolapse.

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Section: Discussionmentioning

confidence: 99%

Quantitative Analysis of Mitral Valve Morphology in Mitral Valve Prolapse With Real-Time 3-Dimensional Echocardiography

et al. 2013

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“…7 Other studies have suggested an association between higher arterial pressure and greater severity of mitral regurgitation in patients with mitral valve prolapse. 8,9 The present study was therefore undertaken to assess the prevalences of mild-to-moderate mitral or aortic regurgitation in patients with hypertension and electrocardiographic LVH, and to determine the impact of these valvular lesions on LV structure and function.…”

mentioning

confidence: 99%

Impact of valvular regurgitation on left ventricular geometry and function in hypertensive patients with left ventricular hypertrophy: the LIFE study

et al. 2004

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Mild-to-moderate aortic and mitral regurgitation are frequently detected by echocardiogram in asymptomatic hypertensive patients. Our goal was to assess the prevalence and impact of mild-to-moderate mitral and/ or aortic regurgitation on left ventricular (LV) structure and function in patients with hypertension and LV hypertrophy (LVH). Hypertensive patients with ECG LVH enrolled in the Losartan Intervention For Endpoint reduction in hypertension (LIFE) echocardiography substudy were evaluated. Among 939 patients with needed LV measurements and Doppler data, 242 had mild (1 þ ) valvular regurgitation, and 51 patients had moderate (2 þ or 3 þ ) regurgitation of one or both valves. In analyses adjusting for gender, patients with mild mitral and/or aortic regurgitation had larger LV internal dimensions (5.25 vs 5.33 cm, Po0.05), higher LV mass indexed for body surface area (122 vs 125 g/m 2 , Po0.05) or height 2.7 (55.4 vs 57.3, Po0.05), and larger left atrial diameter. Patients with moderate regurgitation of one or both valves had larger LV chambers (5.25 vs 5.9 cm, Po0.001), greater mean LV mass (232 vs 248 g, Po0.001) and LV mass indexed for body surface area or height 2.7 , and higher Doppler stroke volume. Patients with moderate valvular regurgitation also had a higher prevalence of LVH due to an increased prevalence of eccentric LVH. There were no differences among groups defined by the presence and severity of valvular regurgitation in cardiac output, total peripheral resistance, or pulse pressure/stroke volume, indicating that the observed inter-group differences in LV geometry were not due to differences in the haemodynamic severity of hypertension. Hypertensive patients with mild-to-moderate mitral or aortic valvular insufficiency have additional LV structural and functional changes that may affect prognosis.

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“…97 Their findings showed a lower cumulative risk of surgery for women with MVP than men (0.8% vs. 2.6%) before age 65 and (1.4% vs. 5.5%) by age 75. In another population-based study, Jones et al studied various MR risk factors in American Indians.…”

Section: Mitral Valve Prolapsementioning

confidence: 90%

“…48,78 MR frequently occurs due to the progression of myxomatous changes in valves with chronic prolapse conditions. 97,118 The major risk factor for myxomatous mitral valve disease is age; however, there have been a few sex-difference studies in humans and in dogs. In one of the early studies, Lax et al reported that mitral valve prolapse occurs more frequently in women by testing a hypothesis that mild dehydration induces mitral valve prolapse.…”

Section: Mitral Valve Prolapsementioning

confidence: 99%

Understanding the Role of Sex in Heart Valve and Major Vascular Diseases

Masjedi

Ferdous

2015

Cardiovasc Eng Tech

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Cardiovascular disease (CVD) is the major cause of mortality in the elderly population. The cost of CVD treatment and surgeries was over $300 billion in the United States alone in 2010, making this disorder a critical healthcare issue. Many studies have suggested sex as a risk factor for heart valve and major vascular diseases, such as aortic valve stenosis, mitral prolapse and regurgitation, atherosclerosis, coronary artery disease, and abdominal aortic aneurysm. Unfortunately, only a handful of studies have illustrated the role of sex in the etiology and progression of these disorders. Moreover, knowledge of biomolecular factors that affect these diseases in men and women is very limited. Numerous clinical studies have revealed obvious differences in the prevalence of these diseases between the sexes. These reports were supported by a few molecular and cellular physiology studies that associated this difference to sex and sex hormones. In particular, male sex has commonly been identified as a risk factor for majority of heart valve and vascular diseases, whereas females have been identified as higher risk for certain disorders as well. In addition, menopause is a critical issue that turns the tables against women and enhances complications in their cardiovascular structure due to hormonal change. In this review, major vascular and heart valve diseases for which sex is associated as a risk factor have been reviewed to highlight the importance of this risk factor in CVDs.

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Severe mitral regurgitation due to mitral valve prolapse: risk factors for development, progression, and need for mitral valve surgery

Cited by 47 publications

References 29 publications

Quantitative Analysis of Mitral Valve Morphology in Mitral Valve Prolapse With Real-Time 3-Dimensional Echocardiography

Quantitative Analysis of Mitral Valve Morphology in Mitral Valve Prolapse With Real-Time 3-Dimensional Echocardiography

Impact of valvular regurgitation on left ventricular geometry and function in hypertensive patients with left ventricular hypertrophy: the LIFE study

Understanding the Role of Sex in Heart Valve and Major Vascular Diseases

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