The Evolution of Mitral Valve Prolapse: Insights from the Framingham Heart Study
Background—Longitudinal studies of mitral valve prolapse (MVP) progression among unselected individuals in the community, including those with non-diagnostic MVP morphologies (NDM), are lacking.
Methods and Results—We measured longitudinal changes in annular diameter, leaflet displacement, thickness, anterior/posterior leaflet projections onto the annulus, coaptation height, and mitral regurgitation (MR) jet height in 261 Framingham Offspring participants at Examination 5 who had available follow-up imaging 3 to 16 years later. Study participants included MVP (N=63), NDM - 'minimal systolic displacement' or MSD (N=50) and the 'abnormal anterior coaptation' (AAC) phenotype (N=10, with coaptation height >40% of the annulus similar to posterior MVP), plus 138 healthy referents without MVP or NDM. At follow-up, individuals with MVP (52% women, 57±11 years) had greater increases of leaflet displacement, thickness, and jet height compared with referents (all p<0.05). Eleven participants with MVP (17%) had ≥ moderate MR (jet height ≥5 mm) and 5 others (8%) underwent mitral valve repair. Of the individuals with NDM, 8 (80%) AACs progressed to posterior MVP; 17 (34%) MSDs were reclassified as either posterior MVP (12) or AAC (5). Compared with the 33 MSDs who did not progress, the 17 who progressed had greater leaflet displacement, thickness, coaptation height, and MR jet height (all p<0.05).
Conclusions—NDM may evolve into MVP, highlighting the clinical significance of mild MVP expression. MVP progresses to significant MR over a period of 3 to 16 years in a quarter of individuals in the community. Changes in mitral leaflet morphology are associated with both NDM and MVP progression.
- Received November 25, 2015.
- Revision received February 10, 2016.
- Accepted March 9, 2016.