Lack of association between mitral valve prolapse and history of rheumatic fever

To determine whether rheumatic fever is associated with mitral valve prolapse (MVP) diagnosed by echocardiography, records from 561 subjects participating in a prospective family study were reviewed. The prevalence of a history of rheumatic fever by modified Jones criteria was determined in 92 probands and 112 affected relatives or spouses with M-mode 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 both 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 rheumatic fever were older than the remaining subjects (48 ± 17 vs 36 ± 20 years, p < 0.01) as expected because of the decline in rheumatic fever in the twentieth century, and subjects with MVP were older than subjects without MVP (39 ± 16 vs 34 ± 22 years, p < 0.01). Multiple logistic regression showed that after the independent relation of older age with a positive history of rheumatic fever (p < 0.01) was taken into account, there was a trend toward a lower likelihood of previous rheumatic fever associated with MVP (odds ratio 0.42, p = 0.07). These results do not support either a true association or a causal role of rheumatic fever in the pattern of mitral leaflet motion and auscultatory abnormalities in adults, for which the term MVP is generally used.