Prevalence, progression, and clinical outcomes of mitral valve prolapse: a systematic review and meta-analysis

The prevalence of mitral valve prolapse (MVP) varies across populations and age groups; its natural history and clinical outcomes remain unclear. This meta-analysis established the prevalence of MVP in the general population, in associated syndromes and at different ages. It also determined the rate of progression and the incidence of adverse outcomes.

A systematic search identified original reports on the prevalence of MVP and related outcomes. A total of 83 studies met inclusion: 47 (n = 992 944) non-syndrome associated; 31 (n = 3067) syndrome associated; and 5 (n = 1287) described mitral regurgitation (MR) progression or adverse outcomes. In the general population, the prevalence was 1.35% but higher in hospital cohorts (8.7%). Age-stratified prevalence was 0.5, 1.8, 2.7, and 2.0% in neonates, children, adolescents and adults, respectively. Meta-regression and subgroup analysis found no significant difference (P = 0.81) across ages but revealed a significantly higher prevalence in older compared to young adults (2.87% vs. 0.67%, P = 0.01). Prevalence rates were markedly higher in patients with genetic syndromes. MR progressed at 5.5 per 100 person-years, overall. Event rates for all-cause mortality, development of heart failure, and need for mitral valve intervention were 1.7, 1.0, and 1.2 per 100 person-years, respectively.

MVP is common, with greater prevalence in syndromes. Although more common with age, MVP is observed in infants. MVP related MR is progressive, especially in moderate MR, and there is a signal of excess mortality for unclear reasons. Valve services must manage the whole life journey and the potential risks associated with MVP.