Natural History of Asymptomatic Mitral Valve Prolapse in the Community

作者：Jean-François Aviérinos, Bernard John Gersh, L. Joseph Melton, Kent R. Bailey, Clarence Shub, Rick A. Nishimura, Abdul Jamil Tajik, Maurice L. Enriquez-Sarano · 发表于：Circulation · 年份：2002 · DOI：10.1161/01.cir.0000028933.34260.09 · 被引用次数：448 · 研究领域：Cardiac Valve Diseases and Treatments、Congenital Heart Disease Studies、Infective Endocarditis Diagnosis and Management

BACKGROUND: The outcome of mitral valve prolapse (MVP) is controversial, with marked discrepancies in reported complication rates. METHODS AND RESULTS: We conducted a community study of all Olmsted County, Minn, residents first diagnosed with asymptomatic MVP between 1989 and 1998 (N=833). Diagnosis, motivated by auscultatory findings (n=557) or incidental (n=276), was always confirmed by echocardiography with the use of current criteria. End points analyzed during 4581 person-years of follow-up were mortality (n=96, 19+/-2% at 10 years), cardiovascular morbidity (n=171), and MVP-related events (n=109, 20+/-2% at 10 years). The most frequent primary risk factors for cardiovascular mortality were mitral regurgitation from moderate to severe (P=0.002, n=131) and, less frequently, ejection fraction <50% (P=0.003, n=31). Secondary risk factors independently predictive of cardiovascular morbidity were slight mitral regurgitation, left atrium > or =40 mm, flail leaflet, atrial fibrillation, and age > or =50 years (all P<0.01). Patients with only 0 or 1 secondary risk factor (n=430) had excellent outcome, with 10-year mortality of 5+/-2% (P=0.17 versus expected), cardiovascular morbidity of 0.5%/y, and MVP-related events of 0.2%/y. Patients with > or =2 secondary risk factors (n=250) had mortality similar to expected (P=0.20) but high cardiovascular morbidity (6.2%/y, P<0.01) and notable MVP-related events (1.7%/y, P<0.01). Patients with primary risk factors (n=153) showed excess 10...