Systemic involvement of connective tissue and the heart as important characteristics of primary mitral valve prolapse

Abstract

Aim. To evaluate systemic involvement of connective tissue (SICT) in young adults with mitral valve prolapse (MVP) without significant mitral regurgitation (MR). Material and methods. We studied 78 asymptomatic young subjects (mean age 19,7±1,6, 72% male) with MVP in comparison with 80 sex- and age-matched healthy subjects. We performed phenotypic examination of MVP patients and control group subjects, and echocardiographic study to identify the minor heart anomalies. Longitudinal strain and strain rate (SR) were determined using spackle tracking (Vivid 7 Dimension GE, EchoPAC’08). Results. We identified two clusters of patients with MVP. In the first cluster (17 subjects, 28% of the MVP group) a significant reduction of longitudinal systolic strain observed comparing to the control group and the second cluster (61 subjects, 72%). Global strain in the second cluster did not differ significantly from the control group. Echocardiographic study showed nonsignificant increase in the average number of SICT points in the first cluster and highly significant increase of the minor heart anomalies’ number in this group of patients. Conclusion. Myocardial deformation assessment allowed to identify the signs of cardiomyopathy in quarter of young asymptomatic patients with MVP. Increasing number of minor heart anomalies in the group with primary MVP and cardiomyopathy allows considering other valve prolapses, dilatation of major vessels, basal and thick LV chords as features of the SICT in primary MVP. A great number of minor heart anomalies in primary MVP may indicate a change in the heart extracellular matrix that can cause the development of cardiomyopathy in primary MVP.