Abstract 4366454: Association of Race with Disease Expression and Clinical Outcomes among Patients with Mitral Valve Prolapse

Abstract

Background: We do not clearly understand racial differences in risk profile, cardiac echocardiographic metrics among mitral valve prolapse (MVP) patients neither are differences in long-term outcome well characterized. Objective: To assess the association between race, echocardiographic parameters, and clinical outcomes among MVP patients. Methods: Baseline demographics, self reported race, echocardiographic data, medication use, and cardiovascular and medical comorbidities were evaluated for white and black patients with echocardiographic evidence of MVP (n=7751) at a large multi-hospital academic health system between 2010-2024. Patients with mitral and aortic valve procedures, mitral or aortic stenosis, infiltrative cardiomyopathies, HCM, EF<35%, and cancer were excluded. Long term outcomes regarding all-cause mortality, cardiovascular (CV) hospitalization for heart failure (HF), atrial fibrillation (AF), stroke and ventricular tachycardia/fibrillation/sudden cardiac arrest (VT/VF/SCA) were evaluated along with cardiac interventions. Multivariable Cox proportional hazard modeling was performed to impact of race on mortality and CV hospitalization. Results: Although black (n=438, 5.6%) patients with MVP were younger (57±2 vs. 62.4±2,P<0.001), they had more cardiovascular risk factors (diabetes (17% vs 7%, p<0.001), hypertension (53% vs 40%, p<0.001) chronic kidney disease (8% vs 3.4%, p<0.001)), higher comorbidity burden (Charlson Comorbidity Index 1.3±1.7 vs 0.73±1.1, p<0.001). Black patients had predominantly anterior MVP involvement (55% vs 29%) and less severe MR at presentation but had lower EF (10% with 35-50% EF) and increased pulmonary artery systolic pressures across age spectrum (Figure 1,2). Black patients experienced significantly increased comorbidity adjusted all-cause mortality (HR 1.2, CI 1-1.5, p=0.05) and CV hospitalizations (HR 1.36, CI1.1-1.6, p=0.003) particularly related to HF and VT/VF/SCA (Figure 2). However, black patients were less likely to undergo surgical mitral valve repair or ICD implantation (Figure 3). Conclusion: Significant racial differences in disease expression, clinical outcomes and healthcare utilization exist between white and non-white mitral valve prolapse patients. Further research is needed to understand valvular phenotype and treatment gaps in MVP patients across racial and ethnic groups to improve outcomes.