Abstract

Background Few studies have evaluated the prevalence or severity of mitral valve prolapse (MVP) and other valvular heart disease (VHD) in the rural US South, where strategies for early detection are crucial for risk stratification and prevention.

Objectives We assessed the prevalence of MVP and other VHD in a rural US South cohort and examined associations with cardiovascular disease (CVD) risk. We also evaluated relationships between MVP severity, high-sensitivity cardiac troponin T (hsTnT), and N-terminal pro-B-type natriuretic peptide (NTproBNP).

Methods We conducted a cross-sectional analysis from the Risk Underlying Rural Areas Longitudinal (RURAL) study. Logistic regression assessed associations between participant characteristics and MVP, other VHD, or both. Weighted models assessed odds for MVP and other VHD by 10-year CVD risk categories using the Predicting Risk of CVD Events (PREVENT) score. Among a subset, we evaluated associations between MVP severity and cardiac biomarkers.

Results Among 2,621 participants (68.7% women), MVP and other VHD were present in 1.9% and 11.2%, respectively. Compared to the low PREVENT risk group, odds of MVP were lower and odds of VHD were higher among borderline and intermediate/high groups. HsTnT was lower in MVP vs. non-MVP (0.64, 95% CI 0.58-0.71), without difference by severity of MVP. NTproBNP was higher in participants with severe MVP than non-MVP (2.05, 95% CI 1.49-2.83).

Conclusions MVP prevalence aligned with population-based epidemiologic studies. PREVENT risk category may differentiate individuals at higher risk for MVP and for other VHD. Future studies are needed to evaluate relationships between MVP/VHD status and clinical events.

Competing Interest Statement

The authors have declared no competing interest.

Funding Statement

This work was supported by grants U01HL146382 and R01HL157531 from the National Heart Lung and Blood Institute (NHLBI).

Author Declarations

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

Ethical approval by the University of Alabama at Birmingham (UAB) Institutional Review Board for Human Use (IRB). All relevant participating RURAL institutions cede review to the UAB IRB which serves as the single IRB for the RURAL Study.

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

Yes

I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

Yes

Footnotes

Author/Funding Disclosures: None

This work was supported by grants U01HL146382 and R01HL157531 from the National Heart Lung and Blood Institute (NHLBI).

Tweet: AI-guided echocardiography offers a novel way to reach rural communities. Studying valvular heart disease (VHD), we found that higher CVD risk is associated with presence of certain VHD. Higher levels of NTproBNP identified individuals with more severe mitral valve prolapse. #cvVHD #HealthEquity #cvEcho

Data Availability

All data produced in the present study are available upon reasonable request to the authors

Abbreviation ListAIArtificial intelligenceMVPMitral valve prolapseVHDValvular heart diseaseCVDCardiovascular diseaseMEUsMobile examination unitsRURALEcho Risk Underlying Rural Areas Longitudinal Echocardiographic Ancillary StudyPREVENTPredicting Risk of CVD EVENTshsTnTHigh-sensitivity cardiac troponin TNTproBNPN-terminal pro-B-type natriuretic peptide