Arrhythmic mitral valve prolapse: Diagnostic parameters for high‐risk patients: A systematic review and meta‐analysis

Oliveri, Federico; Fotios, Kakargias; Panday, Priyanka; Franchini, Ana P Arcia; Iskander, Beshoy; Anwer, Fatima; Hamid, Pousette

doi:10.1111/pace.14338

Cited by 15 publications

(17 citation statements)

References 47 publications

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“…Of MVP patients who do have ventricular arrhythmias (VA, defined as premature ventricular contractions (PVCs), non-sustained ventricular tachycardia (nsVT), sustained ventricular tachycardia (VT) or ventricular fibrillation (VF)), about 65% (range 29-83%) will have T-wave inversions or biphasic T-waves, often in the inferior or inferolateral leads (Figure 2) [4,7,22,29,30,39]. MVP patients with complex VA (PVC burden of at least 5%, ventricular couplets or bigeminy, nsVT, sustained VT/VF) had an odds ratio of 2.73 for T-wave inversions compared with those without VA [49]. Some studies have also reported ST-depression and J point elevations, but it is less clear if these are more common in MVP patients with VA [7,29,39].…”

Section: Electrocardiographic Abnormalitiesmentioning

confidence: 99%

“…Some studies have also reported ST-depression and J point elevations, but it is less clear if these are more common in MVP patients with VA [7,29,39]. Individual studies produced conflicting results on whether patients with MVP with arrhythmias have longer corrected QT intervals [29,30,39,50], but a meta-analysis suggests the corrected QT interval was longer by 14.7 msec [49]. Although the corrected QT interval may be longer on average, the averages are typically not prolonged.…”

Section: Electrocardiographic Abnormalitiesmentioning

confidence: 99%

“…QT dispersion (the difference between the maximum and minimum QT intervals across all 12-leads of a single electrocardiogram) has been shown to be higher in patients with MVP than those with normal hearts and has been correlated with VA, MVP severity, and complex ventricular ectopy in MVP patients [51][52][53][54]. While these findings are thought Individual studies produced conflicting results on whether patients with MVP with arrhythmias have longer corrected QT intervals [29,30,39,50], but a meta-analysis suggests the corrected QT interval was longer by 14.7 msec [49]. Although the corrected QT interval may be longer on average, the averages are typically not prolonged.…”

Section: Electrocardiographic Abnormalitiesmentioning

confidence: 99%

“…The extent of leaflet prolapse has been correlated with SCD with highest risk for bileaflet prolapse [29,39,58]. One meta-analysis reported that MVP patients with bileaflet prolapse had an odds ratio of 1.65 (p value < 0.001) for complex VA (PVC burden of at least 5%, ventricular couplets/bigeminy, nsVT, sustained VT/VF) compared with segmental or single leaflet prolapse [49]. Longer mitral valve leaflet length (either anterior, posterior, or both) has been correlated with SCD but specific numerical cut offs are not clear [30,39,49,54,59].…”

Section: Mitral Valve Characteristicsmentioning

confidence: 99%

“…One meta-analysis reported that MVP patients with bileaflet prolapse had an odds ratio of 1.65 (p value < 0.001) for complex VA (PVC burden of at least 5%, ventricular couplets/bigeminy, nsVT, sustained VT/VF) compared with segmental or single leaflet prolapse [49]. Longer mitral valve leaflet length (either anterior, posterior, or both) has been correlated with SCD but specific numerical cut offs are not clear [30,39,49,54,59]. An older study reported a high rate of SCD in patients with flail leaflets [41], but an association between flail and SCD was not reproduced with a more recent study [39].…”

Section: Mitral Valve Characteristicsmentioning

confidence: 99%

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Arrhythmic Mitral Valve Prolapse and Mitral Annular Disjunction: Clinical Features, Pathophysiology, Risk Stratification, and Management

Chakrabarti

Bogun

Liang

2022

JCDD

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Mitral valve prolapse (MVP) is a common cause of valvular heart disease. Although many patients with MVP have a benign course, there is increasing recognition of an arrhythmic phenotype associated with ventricular arrhythmias and sudden cardiac death (SCD). Pathophysiologic mechanisms associated with arrhythmias include cardiac fibrosis, mechanical stress induced changes in ventricular refractory periods, as well as electrophysiologic changes in Purkinje fibers. Clinically, a variety of risk factors including demographic, electrocardiographic, and imaging characteristics help to identify patients with MVP at the highest at risk of SCD and arrhythmias. Once identified, recent advances in treatment including device therapy, catheter ablation, and surgical interventions show promising outcomes. In this review, we will summarize the incidence of ventricular arrhythmias and SCD in patients with MVP, the association with mitral annular disjunction, mechanisms of arrhythmogenesis, methods for arrhythmic and SCD risk stratification including findings with multimodality imaging, and treatments for the primary and secondary prevention of SCD.

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Section: Electrocardiographic Abnormalitiesmentioning

confidence: 99%

Section: Electrocardiographic Abnormalitiesmentioning

confidence: 99%

Section: Electrocardiographic Abnormalitiesmentioning

confidence: 99%

Section: Mitral Valve Characteristicsmentioning

confidence: 99%

Section: Mitral Valve Characteristicsmentioning

confidence: 99%

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Arrhythmic Mitral Valve Prolapse and Mitral Annular Disjunction: Clinical Features, Pathophysiology, Risk Stratification, and Management

Chakrabarti

Bogun

Liang

2022

JCDD

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Role of cardiac magnetic resonance in stratifying arrhythmogenic risk in mitral valve prolapse patients: a systematic review and meta-analysis

Gatti,

Santonocito,

Papa

et al. 2024

Eur Radiol

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Objectives To perform a systematic review and meta-analysis of studies investigating the diagnostic value of cardiac magnetic resonance (CMR) features for arrhythmic risk stratification in mitral valve prolapse (MVP) patients. Materials and methods EMBASE, PubMed/MEDLINE, and CENTRAL were searched for studies reporting MVP patients who underwent CMR with assessment of: left ventricular (LV) size and function, mitral regurgitation (MR), prolapse distance, mitral annular disjunction (MAD), curling, late gadolinium enhancement (LGE), and T1 mapping, and reported the association with arrhythmia. The primary endpoint was complex ventricular arrhythmias (co-VAs) as defined by any non-sustained ventricular tachycardia, sustained ventricular tachycardia, ventricular fibrillation, or aborted sudden cardiac death. Meta-analysis was performed when at least three studies investigated a CMR feature. PROSPERO registration number: CRD42023374185. Results The meta-analysis included 11 studies with 1278 patients. MR severity, leaflet length/thickness, curling, MAD distance, and mapping techniques were not meta-analyzed as reported in < 3 studies. LV end-diastolic volume index, LV ejection fraction, and prolapse distance showed small non-significant effect sizes. LGE showed a strong and significant association with co-VA with a LogORs of 2.12 (95% confidence interval (CI): [1.00, 3.23]), for MAD the log odds-ratio was 0.95 (95% CI: [0.30, 1.60]). The predictive accuracy of LGE was substantial, with a hierarchical summary ROC AUC of 0.83 (95% CI: [0.69, 0.91]) and sensitivity and specificity rates of 0.70 (95% CI: [0.41, 0.89]) and 0.80 (95% CI: [0.67, 0.89]), respectively. Conclusions Our study highlights the role of LGE as the key CMR feature for arrhythmia risk stratification in MVP patients. MAD might complement arrhythmic risk stratification. Clinical relevance statement LGE is a key factor for arrhythmogenic risk in MVP patients, with additional contribution from MAD. Combining MRI findings with clinical characteristics is critical for evaluating and accurately stratifying arrhythmogenic risk in MVP patients. Key Points MVP affects 2–3% of the population, with some facing increased risk for arrhythmia. LGE can assess arrhythmia risk, and MAD may further stratify patients. CMR is critical for MVP arrhythmia risk stratification, making it essential in a comprehensive evaluation.

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What Do We Know So Far About Ventricular Arrhythmias and Sudden Cardiac Death Prediction in the Mitral Valve Prolapse Population? Could Biomarkers Help Us Predict Their Occurrence?

Dziadosz,

Daniłowicz-Szymanowicz,

Wejner-Mik

et al. 2024

Curr Cardiol Rep

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Purpose of the Review To summarize currently available data on the topic of mitral valve prolapse (MVP) and its correlation to the occurrence of atrial and ventricular arrhythmias. To assess the prognostic value of several diagnostic methods such as transthoracic echocardiography, transesophageal echocardiography, cardiac magnetic resonance, cardiac computed tomography, electrocardiography, and electrophysiology concerning arrhythmic episodes. To explore intra and extracellular biochemistry of the cardiovascular system and its biomarkers as diagnostic tools to predict rhythm disturbances in the MVP population. Recent Findings MVP is a common and mainly benign valvular disorder. It affects 2–3% of the general population. MVP is a heterogeneous and highly variable phenomenon with three structural phenotypes: myxomatous degeneration, fibroelastic deficiency, and forme fruste. Exercise intolerance, supraventricular tachycardia, and chest discomfort are the symptoms that are often paired with psychosomatic components. Though MVP is thought to be benign, the association between isolated MVP without mitral regurgitation (MR) or left ventricle dysfunction, with ventricular arrhythmia (VA) and sudden cardiac death (SCD) has been observed. The incidence of SCD in the MVP population is around 0.6% per year, which is 6 times higher than the occurrence of SCD in the general population. Summary Often asymptomatic MVP population poses a challenge to screen for VA and prevent SCD. Therefore, it is crucial to carefully assess the risk of VA and SCD in patients with MVP with the use of various tools such as diagnostic imaging and biochemical and genetic screening.

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Arrhythmic mitral valve prolapse: Diagnostic parameters for high‐risk patients: A systematic review and meta‐analysis

Cited by 15 publications

References 47 publications

Arrhythmic Mitral Valve Prolapse and Mitral Annular Disjunction: Clinical Features, Pathophysiology, Risk Stratification, and Management

Arrhythmic Mitral Valve Prolapse and Mitral Annular Disjunction: Clinical Features, Pathophysiology, Risk Stratification, and Management

Role of cardiac magnetic resonance in stratifying arrhythmogenic risk in mitral valve prolapse patients: a systematic review and meta-analysis

What Do We Know So Far About Ventricular Arrhythmias and Sudden Cardiac Death Prediction in the Mitral Valve Prolapse Population? Could Biomarkers Help Us Predict Their Occurrence?

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