Mitral leaflet motion: Age and implications for the diagnosis of mitral valve prolapse

The extent of posterior mitral leaflet motion (PMLM) during systole in relation to age was studied in 300 asymptomatic men aged 18–42 years. PMLM of 4 mm or more on two-dimensional directed M-mode echocardiography was found in 8% (16/200) of subjects under age 35 years, but in only 2% (2/100) of those aged 35 years or more (p<0.05). On two-dimensional echocardiography, 16% (31/200) of men under 35 years old had PMLM ≥0.40 mm2 compared with 1% (1/100) of those 35 years or more (p<0.001). The findings were not related to differences in left ventricular cavity dimensions or in the extent of systolic ventricular contraction. Body mass index (BMI) increased with age, but there was a significant and independent negative correlation of age with PMLM after controlling for BMI. The data are compatible with the hypothesis that the aging process is associated with decreased mobility of the mitral valve or annulus with lesser degrees of backward bowing or billowing of the leaflets during systole. Age should be taken into account in determining “normal” values for mitral leaflet motion.