LACK OF ASSOCIATION BETWEEN MITRAL-VALVE PROLAPSE AND HISTORY OF RHEUMATIC-FEVER

To determine whether rheumatic fever is associated with mitral valve p rolapse (MVP) diagnosed by echocardiography, records from 561 subjects participating in a prospective family study were reviewed. The preval ence of a history of rheumatic fever by modified Jones criteria was de termined in 92 probands and 112 affected relatives or spouses with M-m ode and two-dimensional echocardiographic findings of MVP, accompanied in most instances by classic auscultatory findings, and in 357 family members without MVP. The prevalence of rheumatic fever was 5.4% in bo th MVP subgroups and 2.2% in the family members without MVP (p < 0.05 vs the combined MVP group). However, people with a history of rheumati c fever were older than the remaining subjects (48 +/- 17 vs 36 +/- 20 years, p < 0.01) as expected because of the decline in rheumatic feve r in the twentieth century, and subjects with MVP were older than subj ects without MVP (39 +/- 16 vs 34 +/- 22 years, p < 0.01). Multiple lo gistic regression showed that after the independent relation of older age with a positive history of rheumatic fever (p < 0.01) was taken in to account, there was a trend toward a lower likelihood of previous rh eumatic fever associated with MVP (odds ratio 0.42, p = 0.07). These r esults do not support either a true association or a causal role of rh eumatic fever in the pattern of mitral leaflet motion and auscultatory abnormalities in adults, for which the term MVP is generally used.