Significance and prognosis of an isolated late systolic murmur: a 9 to 22 year follow up

Abstract

Sixty two patients with an isolated late systolic murmur, 33 of whom also had a systolic click, were followed for a minimum of 9 yr (mean 13. yr, maximum 22 yr). Most were known to have a murmur for much longer (mean 27 yr, maximum 51 yr). All were thought to have mitral regurgitation that was minimal and primary and not secondary to myocardial disease or ischaemic heart disease. Patients were excluded from the series if there were more than minimal left atrial or left ventricular enlargement on X ray, an abnormal electrocardiogram apart from multiple ventricular ectopics and succeeding flat T waves, or a history of chest pain closely associated with exertion. Four could not be traced but had not been certified as dead at Somerset House, 3 died from irrelevant causes, 1 died from bacterial endocarditis, and 1 died 11 years later aged 75 from increasing mitral regurgitation. In 1 patient there was chordal rupture necessitating valve replacement and in 1 patient bacterial endocarditis caused heart failure. In 10 patients there was slight deterioration, short of the development of symptoms, over a period averaging 11 yr. In 41 patients there was no deterioration over an average of 13.8 yr. Thus the prognosis for a patient with a late systolic murmur as the only abnormal sign is good apart from the risk of bacterial endocarditis (5 cases). There is no justification for the belief that ventricular ectopics in these patients are dangerous and that sudden death occurs, provided that care is taken to exclude patients with myocardial or ischemic heart disease.