Echocardiographic Parameters to Predict Malignant Events in Arrhythmic Mitral Valve Prolapse Population

Abstract

Bileaflet Mitral Valve Prolapse (bMVP) has been linked to major arrhythmic events and sudden cardiac death (SCD). Consistent predictors in this field are still lacking. Echocardiography is the best tool for the analysis of the prolapse and its impact on the ventricular mechanics. The aim of this study was to find new echocardiographic predictors of malignant events within an arrhythmic MVP population. We evaluated 22 patients with bMVP with a transthoracic echocardiogram focused on mitral valve anatomy and ventricular contraction. Six of them had major arrhythmic events who required ICD implantation (ICD-MVP group), while sixteen of them presented with a high arrhythmic burden without major events (A-MVP group). The best predictors of malignant events were the AML length and MD of basal and mid-ventricular segments, while other significant predictors were the larger mitral valve annulus (MVA) indexed area, lower MVA anteroposterior diameter/AML length ratio, higher inferolateral basal S3 velocity and a greater mechanical dispersion (MD) of the basal and mid-ventricular segments.

Arrhythmic risk profile in mitral valve prolapse: A systematic review and metanalysis of 1715 patients

“…Based on this, it could be hypothesized that chronic stretch stress on papillary muscles leads to inflammation, fibroblast proliferation, and subsequent fibrosis deposition, contributing to the development of a proarrhythmic substrate. This mechanism may also explain our finding of increased mechanical dispersion in AMVP patients compared to NAMVP patients, which is consistent with the results reported by Vairo et al 25 …”

“…Based on this, it could be hypothesized that chronic stretch stress on papillary muscles leads to inflammation, fibroblast proliferation, and subsequent fibrosis deposition, contributing to the development of a proarrhythmic substrate. This mechanism may also explain our finding of increased mechanical dispersion in AMVP patients compared to NAMVP patients, which is consistent with the results reported by Vairo et al25 A recent study by Scheirlynck et al20 provided evidence of the relationship between myocardial stretch and VA in AMVP patients.They demonstrated that MVP patients with arrhythmias have higher levels of soluble suppression of tumorigenicity 2, a marker released from stretched myocardium, compared to MVP patients without arrhythmias 20. TWI in inferior and lateral leads may be an electrical manifestation of myocardial distress secondary to stretch stress, rather than the expression of a structural abnormality.…”

Mitral valve prolapse—arrhythmic faces of the valve disease

“…Vairo et al [56] conducted a study, in which they specified some of echocardiographic parameters, which could predict malignant events in arrhythmic MVP patients. They have focused on high-risk features, calculated through spackle tracking analysis, which include: anteroposterior (AP) diameter/AM leaflet (AML) length ratio, the mitral valve annulus indexed area, the inferolateral basal S3 velocity, the AML length, and the basal/mid-ventricular segments mechanical dispersion (DM).…”