title: Mitral valve prolapse in the general population: the benign nature of echocardiographic features in the Framingham Heart Study.
abstract: OBJECTIVE
  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.
authors.affiliation: National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, Massachusetts, USA.
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Freed
authors.forename: Emelia J
authors.initials: EJ
authors.lastname: Benjamin
authors.forename: Daniel
authors.initials: D
authors.lastname: Levy
authors.forename: Martin G
authors.initials: MG
authors.lastname: Larson
authors.forename: Jane C
authors.initials: JC
authors.lastname: Evans
authors.forename: Deborah L
authors.initials: DL
authors.lastname: Fuller
authors.forename: Birgitta
authors.initials: B
authors.lastname: Lehman
authors.forename: Robert A
authors.initials: RA
authors.lastname: Levine
mesh_terms: D000553:Ambulatory Care; D000886:Anthropometry / Q000379:methods; D015982:Bias; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D004452:Echocardiography / Q000379:methods / Q000592:standards*; D005260:Female; D006801:Humans; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D008875:Middle Aged; D008945:Mitral Valve Prolapse / Q000145:classification / Q000000981:diagnostic imaging* / Q000453:epidemiology; D012720:Severity of Illness Index; D013599:Systole