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

Aims: 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.

Methods and results: 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.

Conclusion: 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.