Natural history of the asymptomatic/minimally symptomatic patient with severe mitral regurgitation secondary to mitral valve prolapse and normal right and left ventricular performance

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Abstract

The natural history of patients with severe nonischemic mitral regurgitation (MR) from mitral valve prolapse, who are asymptomatic or minimally symptomatic and have normal right ventricular (RV) and left ventricular (LV) performance, has not been evaluated previously. To define natural history in this population and to determine if any objective variables could predict disease progression, 31 patients were followed annually with severe MR due to prolapse, who at entry were asymptomatic or minimally symptomatic and had normal RV and LV performance at rest by radionuclide cineangiography. Average follow-up in patients not reaching surgical end point was 4.7 years. The Kaplan-Meier product limit estimates were used to determine the rate of progression to either “operable” symptoms or to previously defined “high risk” ventricular performance descriptors, if the latter occurred first. Univariate comparisons of Kaplan-Meier curves and multivariate Cox proportional hazards analyses were used to define prognostically important variables measured at entry. Fourteen patients developed symptoms warranting referral for operation; none developed high-risk ventricular performance descriptors. The annual end point risk was 10.3%. Of all covariates, only change in RV ejection fraction from rest to exercise was significantly associated with disease progression. Annual risk of progression to surgical end point was 4.9% in the subgroup in which this parameter increased with exercise and 14.7% in the subgroup without an increase (p = 0.04). Patients with severe MR due to mitral valve prolapse, who are asymptomatic or minimally symptomatic with normal ventricular performance, can be expected to progress to surgical indications at an annual rate of 10.3%. The change in RV ejection fraction during exercise is useful in predicting the likelihood of such progression.

References (30)

  • MR Zile et al.

    Chronic mitral regurgitation: predictive value of pre-operative echocardiographic indexes of left ventricular function and wall stress

    J Am Coll Cardiol

    (1984)
  • KB Ramanathan et al.

    Natural history of chronic mitral regurgitation: relation of the peak systolic pressure/end systolic volume ratio to morbidity and mortality

    J Am Coll Cardiol

    (1984)
  • HR Phillips et al.

    Mitral valve replacement for isolated mitral regurgitation: analysis of clinical course and late postoperative left ventricular ejection fraction

    Am J Cardiol

    (1981)
  • KE Hammermeister et al.

    Prediction of late survival in patients with mitral valve disease from clinical, hemodynamic, and quantitative angiographic variables

    Circulation

    (1978)
  • A Selzer et al.

    Mitral regurgitation: clinical patterns, pathophysiology and natural history

    Medicine

    (1972)
  • Cited by (0)

    This work was supported in part by Grant RO1-HL-26504 from the National Heart, Lung, and Blood Institute, Bethesda, Maryland, a grant from The Howard Gilman Foundation, New York, New York, and by gifts from The Daniel and Elaine Sargent Charitable Trust, New York, New York, The Lasdon Foundation, New York, New York, Ronald and Jean Schiavone, Whitehouse Station, New Jersey, William and Mary Jane Voute, Bronxville, New York, the Jean I. and Charles H. Brunie Foundation, Bronxville, New York, the David Margolis Foundation, New York, New York, and the A. C. Israel Foundation, Greenwich, Connecticut.

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