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 Yale-New Haven Hospital, New Haven, Connecticut, USA HealthLINK: Women's Health

September 9, 1999

News this month
Mitral valve prolapse: not as common or as serious as thought

Good news for hundreds of thousands of people who may have been misdiagnosed with mitral valve prolapse. Two studies in the July 1 issue of the New England Journal of Medicine conclude the condition has been widely over-diagnosed.

Mitral valve prolapse had been considered the most common cardiac disease in young people, particularly women, and the most common heart valve disease in people of all ages, affecting as many as 35 percent of the population. These new studies indicate it affects only 2.4 percent of the population. And even those who have it do not face a high risk of stroke or heart failure, which were considered relatively common complications.

Thought to affect as much as 35% of the population. . .new studies indicate mitral valve prolapse affects only 2.4%.

What is mitral valve prolapse?
Mitral valve prolapse (MVP) describes what happens when the two flaps in a valve on the left side of the heart fail to close properly, allowing blood to backwash from the left ventricle into the atrium. This can upset the heart’s rhythm, overwork the heart or lead to infection. Symptoms, when they occur, include shortness of breath, chest pains and palpitations. See an animation of mitral valve prolapse.

Framingham Heart Study
Using improved criteria for diagnosis of the defective valve, a group led by Dr. Lisa A. Freed evaluated 1,646 men and 1,845 women and found only 2.4 percent of the population has the usually benign defect. They also found men were just as likely to suffer from the condition as women. Until now, MVP was thought to be more common among women.

The subjects of the study were offspring of the original subjects of a large epidemiological investigation–called the Framingham Heart Study–and their spouses. Diagnoses were based on findings revealed by current two-dimensional echocardiograms using refined criteria for the diagnosis of mitral valve prolapse. The methodology used in the 1970s and 1980s has been recently improved and false positive diagnoses have been minimized.

Two-dimensional echocardiograms using refined criteria for diagnosis are reducing the number of people incorrectly diagnosed as having mitral valve prolapse.

Only 84 of the participants were found to have MVP. And among those 84, only five had serious complications, about the same as the general population. Why is the percentage so much less than those found in previous studies which associated serious complications with the diagnosis? The study’s authors attribute the difference to the population sample. Older studies were conducted in university teaching hospitals where the most seriously ill patients are referred. This study was conducted in Framingham, Mass., a community more representative of the general population.

Massachusetts General Hospital Study
Previous studies have shown between 28 and 40 percent of people who have had strokes have mitral valve prolapse, indicating the possibility the condition might be a risk factor for stroke. The incidence has been reported as even higher among patients younger than 45 years.

Authors of this study examined data on 213 patients 45 years of age or younger who had experienced strokes between 1985 and 1995. All of the subjects were evaluated using the newest diagnostic imaging criteria for detection of MVP.

Previous studies indicated MVP might be a risk factor for stroke, but a new study finds no association between the two.

Four of the 213 patients, or 1.9 percent, were diagnosed with mitral valve prolapse compared to 2.7 percent in a control group, indicating no association between the incidence of stroke and MVP.


Diagnosing mitral valve prolapse

A two-dimensional echocardiogram using state-of-the-art technology, as well as newly evolved criteria for diagnosing mitral valve prolapse, is available at Yale-New Haven Hospital and at the offices of cardiologists affiliated with Yale-New Haven. If you have a diagnosis of mitral valve prolapse you would like to have re-evaluated, call your doctor or 1-888-700-6543 for a referral to a cardiologist affiliated with Yale-New Haven Hospital.

Physician Referral Online

A free and confidential service
of Yale-New Haven Hospital.

Physician Referral Online
Using your own criteria, you can request information from a database of 900 area physicians who have registered to participate.

Request an appointment
We would be happy to assist you in scheduling an appointment with a member of the hospital's medical staff. Use the link above or call:

203-688-2000
or toll free
1-888-700-6543
to talk with a referral coordinator.
Adina Chelouche, M.D.

Mitral valve prolapse frequently misdiagnosed

I strongly suggest that anyone diagnosed with mitral valve prolapse several years ago be retested. New diagnostic imaging technology has made it possible for us to understand the true anatomy of this valve. Before, physicians believed a normal mitral valve was shaped like a saucer. When scans were taken with older echocardiography technology, doctors believed bulges in the valve were an indication of prolapse. The bulges were actually quite normal.

Relying on scans taken with older echocardiography technology, doctors believed bulges in the valve were an indication of prolapse. The bulges were actually quite normal.

We now know that mitral valves are more saddle-shaped, and we have much more accurate criteria for determining if someone in fact does have mitral valve prolapse. We used this updated criteria in the study we did in Framingham on nearly 3,500 men and women. We found slightly more than 2 percent of the population has the condition and only a small percentage of those patients, less than 5 percent, have serious complications such as stroke, atrial fibrillation or congestive heart failure--the same incidence as the general population.

A relief for the misdiagnosed
In the 1970s and 1980s, there was a dramatic spike in the incidence of MVP diagnoses, particularly in young women with unexplained chest pain or heart palpitations. New ultrasound technology enabled physicians to examine hearts easily, and the diagnosis increased in popularity.

And in the 1980s, when several studies showed a high prevalence of prolapse among stroke victims, the condition was linked to stroke in younger patients. Hospital-based studies also indicated the condition could lead to a number of serious complications like heart failure, stroke, reduced blood flow and infection within the heart.

Many people mistakenly diagnosed with mitral valve prolapse lived in constant fear of developing serious complications. They also were considered high risk by insurance companies and could be eliminated from certain kinds of physically demanding jobs. These individuals were also required to take antibiotics every time they underwent a dental procedure to prevent a potentially fatal infection.

The new diagnostic criteria and the results of the two studies in the New England Journal will eliminate this needless anxiety and unnecessary and costly precautions.

The complication rate of patients accurately diagnosed with prolapse is no greater than the general population.

The complication rate of patients who are accurately diagnosed with prolapse is no greater than the general population. Earlier research that indicated many patients were at risk of serious complication was done in large referral centers where the most seriously ill patients were seen, skewing the results. Our study, conducted in a community more representative of the general population, eliminated this bias.

If you have MVP
If you have been diagnosed with prolapse, confirm with your doctor that recent echocardiogram technology was used to make the diagnosis. If not, ask to be retested.

If you do have the condition, understand most cases do not lead to serious complications. Follow your physicians’ advice concerning regular checkups and discuss treatment options. In severe cases, valves can be surgically repaired or replaced with artificial valves.

Dr. Freed, who was the lead author in the research article based on the Framingham Heart Study, is an associate with The Cardiology Group with offices in New Haven and Branford. She is an attending physician at Yale-New Haven Hospital.



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