The Natural History of Unexpected Doppler Mitral Regurgitation

Abstract

It is common for patients to be di agnosed as having valvular regurgita tion by Doppler echo when no such murmur has been heard by the refer ring clinician. To test the hypothesis that such patients have clinically un important heart disease, the authors evaluated the records of 213 consecu tive men in whom mitral regurgita tion had been found by pulsed Doppler. In 95 patients (group I) mi tral regurgitation was audible, whereas in the other 118, it was not. In 97 patients with inaudible mitral regurgitation there were no struc tural mitral valve abnormalities by 2D echo. This group of 97 patients (group II) was defined as having un expected Doppler mitral regurgita tion. In group II patients there was a high prevalence of hypertension (50%), congestive heart failure (44%), alcohol abuse (46%), diabetes (27%), coronary artery disease (63%), and atrial fibrillation (13%). The following variables were distrib uted similarly in groups I and II: sur vival time, age, presence of congestive heart failure or coronary artery disease, left ventricular short- axis end diastolic and end systolic di mensions, E point septal separation, and the severity of dyssynergy. Atrial fibrillation was more common in group I (p = 0.017), and group I pa tients had a higher Quetelet's Index (weight/ height squared) (p=0.03). In group II, the factors most closely related to survival were the presence of dyssynergy, of atrial fibrillation, or of congestive heart failure. Al though no group II patient had endo carditis or required mitral valve replacement, their survival was markedly decreased compared with people of similar age in the general population. The majority of car diogenic deaths in group II patients were due to coronary artery disease. These data suggest that unexpected mitral regurgitation is common but is not a benign condition. Rather, it is associated with decreased survival due largely to the presence of ische mic heart disease.