Mitral valve prolapse with a late-systolic regurgitant murmur may be associated with significant hemodynamic consequences

Mustafa I. Ahmed, Thriveni Sanagala, Thomas Denney, Seidu Inusah, David McGiffin, Donald Knowlan, Robert A. O'Rourke, Louis J. Dell'Italia

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The late-systolic murmur of mitral regurgitation (MR) in degenerative mitral valve disease is widely believed to represent regurgitation of a degree that is not associated with hemodynamic significance. However, the extent of left ventricular (LV) remodeling associated with the late-systolic murmur has not been systematically assessed. Accordingly, we studied 82 patients sent for evaluation of at least moderate isolated MR by echocardiography/Doppler examination. All patients had a physical examination and cardiac magnetic resonance imaging to measure LV volumes by summation of serial short-axis slices. Forty-five patients had a pan-systolic murmur and 37 had a late-systolic murmur on auscultation that was verified by timing of onset of regurgitant turbulence by cine magnetic resonance imaging. Systolic blood pressures (124 ± 3 versus 124 ± 3 mm Hg) and LV ejection fraction (61 ± 1% versus 61 ± 1%) did not differ significantly between pan-systolic and late-systolic murmur groups. Although LV end-diastolic volume index was greater in the pan-systolic versus late-systolic murmur (108 ± 4 versus 95 ± 4 mL/m, P = 0.007), both groups were significantly greater than normals (68 ± 2 mL/m, P < 0.0001). However, LV end-systolic volume index (42 ± 2 versus 38 ± 2 mL/m) and LV end-systolic dimension (38 ± 1 versus 37 ± 1 mm), critical markers of adverse LV remodeling in isolated MR, did not differ significantly between pan-systolic and late-systolic murmur groups. In conclusion, the late systolic isolated MR murmur may be associated with significant adverse LV remodeling, and should not be considered evidence of hemodynamically unimportant MR.

Original languageEnglish
Pages (from-to)113-115
Number of pages3
JournalThe American Journal of the Medical Sciences
Issue number2
Publication statusPublished - Aug 2009
Externally publishedYes


  • Auscultation
  • Mitral regurgitation
  • Mitral valve prolapse

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