SYSTEMIC INVOLVEMENT OF CONNECTIVE TISSUE AND THE HEART AS IMPORTANT CHARACTERISTICS OF PRIMARY MITRAL VALVE PROLAPSE

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.

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