Correlations of Leaflet-Prolapse Location with Progression of Primary Mitral Regurgitation and Left Ventricular Fractional Shortening: An Observation Echocardiographic Study

Aim:
We sought to investigate the distribution pattern of scallop involvement in mitral valve prolapse and whether different patterns could predict the severity of mitral regurgitation (MR) and its progression.

Methods:
We retrospectively included 299 MVP patients with at least moderate MR (aged 61±15, 34% women) who had been followed in our echocardiographic laboratory between 1996 and 2016. Mean follow up was 8 ±4 years. All patients had at least 2 echocardiographic studies 4 years apart or more. We compared the index (first) study to the second one. Patients were classified according to the anatomic involvement: anterior prolapse (AMP), posterior prolapse (PMP), and bi-leaflet prolapse (BMP). The echocardiographic parameters were compared between the 2 serial studies and distinguished by the scallop involvement

Results:
The prevalence of AMP, PMP and BMP on initial study was 15%, 47% and 38%, respectively. Progression to BMP was observed in 16% of the patients with AMP and in 5% of patients with PMP. Worsening of MR was observed in 54% of patients: 51% with AMP, 58% with PMP, and 52% with BMP (p=0.61). The changes in echocardiographic parameters according to the 3 pre-classified morphologies are presented in the Table. The LV and LA dimensions, and the TR grade and gradients increased over time but there were no significant differences between subclasses distinguished by morphology. However, the fractional shortening decreased significantly only in the PMP group (p=0.03.)

Conclusions:
In this group of patients with MVP, the prolapse location was not related to MR progression. Our observation that fractional shortening worsens more in patients with PMP involvement could impact the clinical prognosis during follow up.

Table:The mean differences in echocardiographic measurments between the first and last echocardiographic studies