Prevalence of Mitral Valve Prolapse: a Systematic Review and Meta-Analysis

Abstract

Introduction The prevalence of Mitral valve prolapse (MVP) varies between different populations and age groups and is poorly understood, with figures ranging from 0.6 -15%. A more precise estimate is paramount for planning echocardiography service provision. This meta-analysis aims to determine the prevalence of MVP in two distinct populations: general (non-syndromic) and syndromic (based on known syndrome associated with MVP). Methods A systematic search was conducted using MEDLINE, EMBASE, and the Cochrane Library databases until July 2023 to identify studies reporting the prevalence of MVP diagnosed by two-dimensional transthoracic echocardiography. Prevalence estimates and their 95% confidence intervals (CI) were pooled using random effects model. Subgroup analysis based on age group and echo diagnostic criteria were conducted. 'Leaveone- out' sensitivity analysis was also performed to assess the robustness of the findings. Syndromes assessed included Marfan's, Ehlers-Danlos and Williams-Beuren. Results 78 studies with 996,011 patients were included: 47 (n=992,944) non-syndromic and 31 (n=3067) syndromic. The pooled prevalence in the general population was 2.59% (95% CI 1.88-3.55%). When stratified by age, the prevalence in neonates was 0.48%, children 1.81%, adolescents 2.70% and adults 2.02% (figure 1). Subgroup analyses across these age groups showed a non-significant difference (p=0.81). There was, however, a significant difference when specifically comparing non-young adults to young adults (2.87% vs. 0.67, p=0.01). Diagnostic criteria strongly influenced MVP prevalence (p 2 mm (figure 2). Greater MVP prevalence was observed in patients with syndromes. Marfan's was associated with the highest prevalence at 57.16%, followed by Williams-Beuren at 18.36% and Ehlers-Danlos at 8%. The 'leave-one-out' sensitivity analysis remained consistent with the results of the main analysis. Conclusions This meta-analysis suggests: the total prevalence of MVP is 2.59% in the general population, is present across all ages, with a greater prevalence in older age and markedly increased prevalence in specific syndromes. The choice of identification technique may amplify the presence by up to a factor of 4. The observed variations underscore the importance of tailored identification strategies, supported by application of precise diagnostic criteria, to guide accurate diagnosis.