SHA24/019007

PREVALENCE OF MITRAL VALVE PROLAPSE AND ITS ADVERSE SEQUELAE IN HEALTHY ADULT YEMENIS BY \ DR: Dhaifullah Jayed Ass.Prof:Thamar Uni Consultant Cardiologist DR: Mohammed Al-yazidi Consultant Cardiologist

GHA 10, SHA24. 13 FEB 2013

INTRODUCTION  Mitral valve prolapse (MVP) is a condition characterized

by systolic displacement of an abnormally thickened, redundant mitral valve leaflets into the left atrium during systole¹.  Mitral valve prolapse is a common cardiac disorder, with prevalence generally ranging from 5-15 percent in most of studies and up to 35 percent in some studies¹¹⁻¹⁷.  MVP is associated with several complications such as bacterial endocarditis, severe mitral regurgitation, atrial fibrillation, syncope and stroke² ⁻⁷.

PREVALENCE OF MITRAL VALVE PROLAPSE AND ITS ADVERSE SEQUELAE IN HEALTHY ADULT YEMENIS

by : Dr. Dhaifullah Jayed

Objectives

PREVALENCE OF MITRAL VALVE PROLAPSE AND ITS ADVERSE SEQUELAE IN HEALTHY ADULT YEMENIS

by : Dr. Dhaifullah Jayed

Methods Study population:  Study established in Al-Kuwait university hospital Sana'a

from 2004-2008 as a prospective study

 Includes 1164 healthy Yemeni individuals, 615 women and

549 men, ranging in age from 18-70 years with (mean age ± SD 45.7 ± 10 years).  Population includes presumably healthy individuals accompanied the patients who have been referred for echocardiographic and abdominal ultrasonographic department.

PREVALENCE OF MITRAL VALVE PROLAPSE AND ITS ADVERSE SEQUELAE IN HEALTHY ADULT YEMENIS

by : Dr. Dhaifullah Jayed

: Two-dimensional echocardiography with commercially available system Sonos 5500,) Hewlett-Packard) that used a 2.5. MHz transducer

Echocardiography The 2-D echocardiographic criteria based on the 3-D shape of the annulus and clinical correlation were used to diagnose mitral valve prolapse according to the maximal superior displacement of the mitral valve leaflets during systole relative to the line connecting the annular-hing points.

Thickness of the mitral valve leaflets during diastasis was measured from the leading to the trailing edge of the thickest area of the mid-portion of the leaflets.

PREVALENCE OF MITRAL VALVE PROLAPSE AND ITS ADVERSE SEQUELAE IN HEALTHY ADULT YEMENIS

by : Dr. Dhaifullah Jayed

NON-CLASSICAL PROLAPSE

CLASSICAL PROLAPSE

 Classical prolapse if

 Nonclassic prolapse if

displacement exceeded 2 mm and maximal thickness was at least 5mm.

displacement exceeded 2 mm but the maximal thickness was less than 5 mm

PREVALENCE OF MITRAL VALVE PROLAPSE AND ITS ADVERSE SEQUELAE IN HEALTHY ADULT YEMENIS

by : Dr. Dhaifullah Jayed

M.V.P. MEASURMENTS

THICKENING OF LEAFLETS IN DIASTOLE

MVP IN SYSTOLE

PREVALENCE OF MITRAL VALVE PROLAPSE AND ITS ADVERSE SEQUELAE IN HEALTHY ADULT YEMENIS

by : Dr. Dhaifullah Jayed

:Clinical characteristics

PREVALENCE OF MITRAL VALVE PROLAPSE AND ITS ADVERSE SEQUELAE IN HEALTHY ADULT YEMENIS

by : Dr. Dhaifullah Jayed

Statistical analysis used statistical software (version 6.11, SAS institute, cary, N.C) in all calculations in our study.

1. MVP 2. NON-MVP

PREVALENCE OF MITRAL VALVE PROLAPSE AND ITS ADVERSE SEQUELAE IN HEALTHY ADULT YEMENIS

by : Dr. Dhaifullah Jayed

Results PREVALENCE OF MITRAL VALVE PROLAPSE AND ITS ADVERSE SEQUELAE IN HEALTHY ADULT YEMENIS

by : Dr. Dhaifullah Jayed

Table 1 :Prevalence of Various Clinical Characteristics Characteristic s

Classical MVP )N= 40(

Chest pain

4 (10%)

Non-classical MVP (N= 34) 3 (8.8%)

Dyspnea Cigarette smoking Hypertension Diabetes mellitus Hypercholestr olemia

3 ( 7.5% )

3 (8.8% )

80(7.3%)

N.S

7 ( 17.5% )

6 ( 16.7% )

110(10.1%)

N.S

6 (15.0% )

5 (14.7% )

150(13.8%)

N.S

0

0

0

N.S

5 (12.5% )

6 (17.6% )

140(12.8%)

N.S

PREVALENCE OF MITRAL VALVE PROLAPSE AND ITS ADVERSE SEQUELAE IN HEALTHY ADULT YEMENIS

No MVP

P-value

( N= 1090) 95(8.7%)

N.S

by : Dr. Dhaifullah Jayed

Prevalence of mitral valve prolapse

PREVALENCE OF MITRAL VALVE PROLAPSE AND ITS ADVERSE SEQUELAE IN HEALTHY ADULT YEMENIS

by : Dr. Dhaifullah Jayed

Table 3 : Prevalence of Various Clinical Findings According to the Presence or Absence of Mitral Valve Prolapse Clinical Findings

Mitral Valve Prolapse (N= 74)

No Mitral Valve Prolapse N=1090

Atrial fibrillation

0

0

Cerebrovascular disease.

1 ( 1.3% )

0

Syncope

2 ( 2.7% )

1( 0.09% )

Heart failure

0

0

PREVALENCE OF MITRAL VALVE PROLAPSE AND ITS ADVERSE SEQUELAE IN HEALTHY ADULT YEMENIS

by : Dr. Dhaifullah Jayed

Table 4: PHYSICAL FINDINGS Variables Body-mass index ** waist-to-hip ratio ** Systolic BP mmHg *** Diastolic BP mmHg Systolic murmur **** Mid-systolic click ****

Classic MVP

No MVP

P- values*

23.1± 0.1

)N= 1090 ( 26.1± 0.2

< 0.001

0.8 ± 0.11

0.79 ± 0.01

0.89 ± 0.001

0.007

120 ± 1.3

120.1.2

123 ± 0.1

N.S

70 ± 0.1

70 ± 0.4

72 ± 0.2

N.S

20 ( 50% )

16 ( 47.1% )

45 ( 4.1% )

< 0.001

19 ( 47.5% )

11 ( 32.3% )

3 (0.3% )

< 0.001

) N= 40) 23.3 ± 0.3

Non-classic MVP )N = 34)

PREVALENCE OF MITRAL VALVE PROLAPSE AND ITS ADVERSE SEQUELAE IN HEALTHY ADULT YEMENIS

by : Dr. Dhaifullah Jayed

Table 5 : E.C.G. FINDINGS Variables

Classic MVP

Non-classic MVP

No MVP

) N= 40)

)N = 34)

)N= 1090 (

Atrial ectopy

3 ( 7.5 % )

1 (2.9% )

15(1.4%)

V. ectopy

1 ( 2.5% )

0

0

N.S

L.A.E.

0

0

0

N.S

L.V.H.

0

0

0

N.S

PREVALENCE OF MITRAL VALVE PROLAPSE AND ITS ADVERSE SEQUELAE IN HEALTHY ADULT YEMENIS

P- values*

< 0.05

by : Dr. Dhaifullah Jayed

DISCUSSION

PREVALENCE OF MITRAL VALVE PROLAPSE AND ITS ADVERSE SEQUELAE IN HEALTHY ADULT YEMENIS

by : Dr. Dhaifullah Jayed

Mitral valve prolapse has been described as the most common cardiac valvular abnormality in industrialized countries²². Previous studies show a large variations of prevalence ranging from 5% upto 35%¹¹⁻¹⁷, but the subjects have largely been volunteers¹²¹³¹ ̓ ̓ ⁶, some self referred and some self selected. In two studies¹³¹̓ ⁶, subjects were selected from large clinic or hospital practices. Such studies are subjects to select many bias and did not reflect prevalence in general population. In addition to that, previous studies used old criteria for diagnosing MVP by echocardiography.

PREVALENCE OF MITRAL VALVE PROLAPSE AND ITS ADVERSE SEQUELAE IN HEALTHY ADULT YEMENIS

by : Dr. Dhaifullah Jayed

New criteria as mentioned above has revealed marked reduction in prevalence of mitral valve prolapse by several recent studies to be on the range of 2-4% in general population studies²⁷ Our present study show a prevalence of mitral valve prolapse by 6.3% which is between the higher prevalence seen on many previous studies¹¹¹², ̓ and near the lower prevalence revealed by framingham heart study²⁷, which is considered comminuty-based study, and consistent with other study¹³. Chest pain, dyspnea were similar in the group of subjects with mitral valve prolapse and those without prolapse and that is consistent with previous reports²³²̓ ⁶.

PREVALENCE OF MITRAL VALVE PROLAPSE AND ITS ADVERSE SEQUELAE IN HEALTHY ADULT YEMENIS

by : Dr. Dhaifullah Jayed

CONCLUSION

PREVALENCE OF MITRAL VALVE PROLAPSE AND ITS ADVERSE SEQUELAE IN HEALTHY ADULT YEMENIS

by : Dr. Dhaifullah Jayed

Conclusion  The prevalence of mitral valve prolapse in adult

Yemenis was 6.3 percent which is similar to other studies in different countries  The low prevalence of adverse sequelae in our study in compare to other studies is explained by the nonselective general popoulation based study we applied.

PREVALENCE OF MITRAL VALVE PROLAPSE AND ITS ADVERSE SEQUELAE IN HEALTHY ADULT YEMENIS

by : Dr. Dhaifullah Jayed

REFERENCES

PREVALENCE OF MITRAL VALVE PROLAPSE AND ITS ADVERSE SEQUELAE IN HEALTHY ADULT YEMENIS

by : Dr. Dhaifullah Jayed

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PREVALENCE OF MITRAL VALVE PROLAPSE AND ITS ADVERSE SEQUELAE IN HEALTHY ADULT YEMENIS

by : Dr. Dhaifullah Jayed

 Levy D, Savage D. Prevalence and clinical features of mitral valve prolapse. Am Heart J 1987;113:1281-1290  Markiewicz W, Stoner J, London E, Hunt SA, Popp RL. Mitral valve prolapse in one hundred presumably healthy young females. Circulation 1976;53:464-473  Procacci PM, Savran SV, Schreiter SL, Bryson AL. Prevalence of clinical mitral-valve prolapse in 1169 young women. N Engl J Med 1976;294:1086-1088  Savage DD, Garrison RJ, Devereux RB, et al. Mitral valve prolapse in the general population. 1. Epidemiologic features: the Framingham Study. Am Heart J 1983;106:571-576  Savage DD, Devereux RB, Garrison RJ, et al. Mitral valve prolapse in the general population. 2. Clinical features: the Framingham Study. Am Heart J 1983;106:577-581  Bryhn M, Persson S. The prevalence of mitral valve prolapse in healthy men and women in Sweden. Acta Med Scand 1984;215:157-160  Warth DC, King ME, Cohen JM, Tesoriero VL, Marcus E, Weyman AE. Prevalence of mitral valve prolapse in normal children. J Am Coll Cardiol 1985;5:1173-1177  Spirito P, Chiarella F, Carratino L, Berisso MZ, Bellotti P, Vecchio C. Clinical course and prognosis of hypertrophic cardiomyopathy in an outpatient population. N Engl J Med 1989;320:749-755.

PREVALENCE OF MITRAL VALVE PROLAPSE AND ITS ADVERSE SEQUELAE IN HEALTHY ADULT YEMENIS

by : Dr. Dhaifullah Jayed

 Maron BJ, Casey SA, Poliac LC, Gohman TE, Almquist AK, Aeppli DM. Clinical course of hypertrophic cardiomyopathy in a regional United States cohort. JAMA 1999;281:650-655  Sahn DJ, Wood J, Allen HD, Peoples W, Goldberg SJ. Echocardiographic spectrum of mitral valve motion in children with and without prolapse: the nature of the false positive diagnosis. Am J Cardiol 1977;39:422-431  Markiewicz W, London E, Popp RL. Effect of transducer placement on echocardiographic mitral valve motion. Am Heart J 1978;96:555-556  Devereux RB, Kramer-Fox R, Kligfield P. Mitral valve prolapse: causes, clinical manifestations, and management. Ann Intern Med 1989;11:305-317  Devereux RB, Kramer-Fox R, Brown WT, et al. Relation between clinical features of the mitral prolapse syndrome and echocardiographically documented mitral valve prolapse. J Am Coll Cardiol 1986;8:763-772  Kannel WB, Wolf PA, Garrison RJ, eds. The Framingham Study: an epidemiological investigation of cardiovascular disease. Section 35. Survival following initial cardiovascular events: 30 year follow-up. Bethesda, Md.: National Heart, Lung, and Blood Institute, 1988. (NIH publication no. 88-2969.)  Kannel WB, Gordon T, eds. The Framingham Study: an epidemiological investigation of cardiovascular disease. Section 30. Some characteristics related to the incidence of cardiovascular disease and death: Framingham Heart Study, 18-year follow-up.

Washington, D.C.: Government Printing Office, 1974. (DHEW publication no. NIH-74PREVALENCE OF MITRAL VALVE PROLAPSE AND ITS ADVERSE SEQUELAE IN HEALTHY ADULT YEMENIS by : Dr. Dhaifullah Jayed 599.)

26-Levy D, Labib SB, Anderson KM, Christiansen JC, Kannel WB, Castelli WP. Determinants of sensitivity and specificity of electrocardiographic criteria for left ventricular hypertrophy. Circulation 1990;81:815-820 27-Freed LA, Levy D, Levine RA, et al. Prevalence and clinical outcome of mitral-valve prolapse. N Engl J Med. 1999;341:1–7. 28-Wilcken DEL, Hickey AJ. Lifetime risk for patients with mitral valve prolapse of developing severe valve regurgitation requiring surgery. Circulation 1988;78:1014 29-Devereux RB, Frary CJ, Kramer-Fox R, Roberts RB, Ruchlin HS. Costeffectiveness of infective endocarditis prophylaxis for mitral valve prolapse with or without a mitral regurgitant murmur. Am J Cardiol 1994;74:1024-1029

PREVALENCE OF MITRAL VALVE PROLAPSE AND ITS ADVERSE SEQUELAE IN HEALTHY ADULT YEMENIS

by : Dr. Dhaifullah Jayed

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