Mortality, Hospitalization, and Cardiac Interventions Among Patients With Mitral Valve Prolapse <65 Years of Age

Background Patients with mitral valves prolapse have a heterogeneous course, and long‐term outcomes among those <65 years of age are unclear. Methods Patients <65 years of age with echocardiographic evidence of MVP at a multihospital academic health system between 2010 and 2024 were evaluated, and all‐cause mortality, cardiovascular hospitalization for heart failure, atrial fibrillation, and ventricular arrhythmias (ventricular tachycardia/ventricular fibrillation/sudden cardiac arrest) were ascertained using multivariable Cox proportional hazard modeling and competing risk analysis. Results The study population comprised 4405 patients with MVP (mean age 49±13 years, 16% <35 years of age, 23% 35–50 years of age, 40% men, 92% White) with anterior MVP versus posterior MVP versus bileaflet MVP noted in 34% versus 33% versus 33%, respectively, whereas 16% had moderate or greater mitral regurgitation. Over a median follow‐up of 7.8±4 years, 313 patients (7%) died, whereas 11% experienced cardiovascular hospitalization (heart failure: 6.5%, atrial fibrillation: 4%, ventricular tachycardia/ventricular fibrillation/sudden cardiac arrest: 1.4%). Defibrillator implantation was performed in 24 (0.5%), whereas 55 (1.2%) patients underwent surgical mitral valve replacement/repair. Presence of anterior MVP (hazard ratio [HR], 1.7 [95% CI, 1.2–2.4]; P =0.003), mitral annular calcification (HR, 2.15 [95% CI, 1.4–3.2]; P <0.001), pulmonary artery systolic pressure (HR, 1.02 [95% CI, 1.02–1.03]; P <0.001), and relative wall thickness (HR, 4.7 [95% CI, 1.2–18]; P =0.022) were independent predictors of mortality. Cardiovascular hospitalization was associated significantly with mitral regurgitation severity (HR increase, 1.1–6.7) and presence of left atrial enlargement (HR, 1.4 [95% CI, 1.03–1.9]; P =0.03). Conclusions In a large contemporary real‐world cohort of patients <65 years of age with MVP, the clinical and echocardiographic profile varies by age at presentation and MVP subtype with appreciable morbidity and mortality.