Clinical Presentation of Mitral Valve Prolapse in the Elderly Population

Introduction: MVP is a relatively common cause of mitral regurgitation (MR). MVP most frequently occurs in young-adults patients. However, MVP first presentation may occur in elderly patients with occasionally more severe clinical manifestations.

The aim of this study was to investigate the predisposing factors for first clinical presentation of mitral valve prolapse (MVP) in older patients (65>y) compared to young adults (<65y).

Methods and Results: Ninety patients, with first clinical presentation of MR due to MVP in the age above 65 years (group1), were compared to 96 patients with MVP under the age of 65 (group 2). The mean age of group 1 was 77±10y and the age of group 2 was 53 ± 6y.
Sixty-two percent of group 1 were female and 54 % in group 2 (p=0.3). Two-thirds of patients in group 1 had a history of hypertension, compared to 36% in group 1 (p=0.001). The rate of coronary artery disease was also significantly higher in group 1(49% vs 17%, p<0.001). There were no differences between the groups in the history of diabetes mellitus and hyperlipidemia. Atrial fibrillation was more frequent in group 1 (p=0.001)

Among older patients with MVP, 52% presented with moderate or severe MR compared with 29% young adults with MVP (p=0.004). There were no differences in left ventricular size between the groups, though septal and posterior wall thickness and left atrial diameter were significantly higher in group 1. Moderate and severe tricuspid regurgitation and pulmonary artery pressure were significantly more advanced in group 1 subjects (21% vs 3%, p=0.01 and 39±8 vs 32.5±6, p=0.001).

Conclusion: Older subjects (>65) that present with MVP, have signs of advanced myocardial damage.
The presentation of significant MR goes along with these findings. However, the higher frequency of hypertension, coronary artery disease and atrial fibrillation are important co-factors.