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- Newsgroups: sci.med
- Path: sparky!uunet!psinntp!newstand.syr.edu!rodan.acs.syr.edu!mdkline
- From: mdkline@rodan.acs.syr.edu (Mark D. Kline)
- Subject: Re: Mitral Valve Prolapse
- Message-ID: <1992Jul20.181040.18635@newstand.syr.edu>
- Organization: Syracuse University, Syracuse, NY
- References: <1623@hsdndev.UUCP> <1992Jul19.223030.1409@newstand.syr.edu> <1628@hsdndev.UUCP>
- Distribution: usa
- Date: Mon, 20 Jul 92 18:10:40 EDT
- Lines: 72
-
- In article <1628@hsdndev.UUCP> rind@binoc.bih.harvard.edu (David Rind) writes:
- >In article <1992Jul19.223030.1409@newstand.syr.edu>
- > mdkline@rodan.acs.syr.edu (Mark D. Kline) writes:
- >>There are several convincing studies and reviews and the clinical experience
- >>of both psychiatrists and cardiologists supports this widely recognized
- >>association. See for example Klein DF, Gorman J: J Clin Psychiatry
- >>1985;2:14-17 (monograph).
- >
- >To be convincing, I would expect a population based cohort study that
- >identified patients with MVP independent of any symptoms, and followed
- >them forward (without telling them they had MVP -- not unreasonable
- >for the benign types of MVP) to look for the development of symptoms.
- >Obviously the person evaluating for the development of anxiety would
- >have to be blinded to the diagnosis as well.
-
- Demanding criteria allright.
-
- >
- >I haven't seen any studies that even come close to this design. If
- >you know of one, I will happily go look it up. I am unimpressed by
- >the "clinical experience" of cardiologists and psychiatrists -- there
- >is a large reason to expect referral bias. This is like the ENT
- >physician who told me he thought penicillin 250mg qid was inadequate
- >for strep throat since he kept seeing patients who failed this therapy.
- [ stuff deleted ]
-
- I don't think the referral bias problem is really the same in these
- two clinical situations. I value clinical experience, although
- I recognize its limitations.
-
-
- >>I stand by my point here; care to cite a study suggesting
- >>increased mortality among people with MVP?
- >
- >Sure -- Look at the New England Journal: Marks AR et al. April 20,
- >1989 1031-36. Patients with MVP who had redundant mitral valve tissue
- >had higher rates of endocarditis and need for mitral valve replacement.
- >Given that both these conditions have a fairly high mortality, this
- >suggests that this form of MVP is associated with higher mortality.
-
- The article you cite supports my original point that MVP as an isolated
- cardiac finding is benign. They suggest that if the i
- mitral valve is prolapsed, and has thick leaflets redundant tissue, THEN
- you are at higher risk of eventual complications. Without these findings
- MVP is benign.
-
- I call your attention to the editorial appearing in the same issue
- of that journal by Dr. Richard B Devereux of Cornell, entitled
- "Diagnosis and Prognosis of Mitral Valve Prolapse", which states in part:
-
- "...calculations suggest that 4000 sudden deaths per year may be
- attributable to mitral valve prolapse. Although these are relatively
- large numbers in absolute terms, they represent a very small fraction
- of the almost seven million patients with MVP in this country..."
-
- Devereux goes on to suggest that young, female patients without systolic
- murmur in the absense of endocarditis are probably at "extremely low risk."
- Devereaux also points out the limitations of the study you cite
- (selective population, no systematic auscultation, and finally,
- uncertainty as to whether the thickened and enlarged valve leaflets
- preceed and predict complications or whether they are
- "wear and tear" phenomena accompanying mitral valve regurgitation.
- (p. 1078)).
-
- I hope this controversy is finally reasurring to the anxious people out
- there who have uncomplicated mitral valve prolapse.
-
- --
- =================================================================
- mark kline mdkline@mailbox.syr.edu
- suny health science center, syracuse voice: (315) 422-1050
- ================= courtesy of syracuse university ================
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