Mitral Valve Prolapse and Sudden Cardiac Death: A Systematic Review

Abstract

Background The relationship between mitral valve prolapse ( MVP ) and sudden cardiac death ( SCD ) remains controversial. In this systematic review, we evaluate the relationship between isolated MVP and SCD to better define a potential high‐risk subtype. In addition, we determine whether premortem parameters could predict SCD in patients with MVP and the incidence of SCD in MVP . Methods and Results Electronic searches were conducted in PubMed and Embase for all English literature articles published between 1960 and 2018 regarding MVP and SCD or cardiac arrest. We also identified articles investigating predictors of ventricular arrhythmias or SCD and cohort studies reporting SCD outcomes in MVP . From 2180 citations, there were 79 articles describing 161 cases of MVP with SCD or cardiac arrest. The median age was 30 years and 69% of cases were female. Cardiac arrest occurred during situations of stress in 47% and was caused by ventricular fibrillation in 81%. Premature ventricular complexes on Holter monitoring (92%) were common. Most cases had bileaflet involvement (70%) with redundancy (99%) and nonsevere mitral regurgitation (83%). From 22 articles describing predictors for ventricular arrhythmias or SCD in MVP , leaflet redundancy was the only independent predictor of SCD . The incidence of SCD with MVP was estimated at 217 events per 100 000 person‐years. Conclusions Isolated MVP and SCD predominantly affects young females with redundant bileaflet prolapse, with cardiac arrest usually occurring as a result of ventricular arrhythmias. To better understand the complex relationship between MVP and SCD , standardized reporting of clinical, electrophysiological, and cardiac imaging parameters with longitudinal follow‐up is required.

Monocyte to high-density lipoprotein ratio: a prognostic factor for mitral valve prolapse?

“…Hui-Chen Han at al. indicated that electrophysiological changes include frequent ventricular premature complex on holter monitoring and ventricular fi brillation as the predominant cardiac arrest rhythm in mitral valve prolapse in a review (6).…”

Value of echocardiogram in predicting sudden cardiac death: A look beyond ejection fraction

“…Most of the patients who had SCD had bileaflet involvement (70%) with redundant leaflets (99%), and majority did not have severe regurgitation (83%). Overall young females with redundant bileaflet prolapse had the highest risk of ventricular arrhythmias and SCD . A spiked configuration of the lateral annular velocities by echocardiography is also described as a marker of risk of SCD in MVP .…”

“…The association of mitral valve prolapse (MVP) and SCD is not clear. Ventricular fibrillation was the major cause (81%) for sudden death in patients with mitral valve prolapse . Most of the patients who had SCD had bileaflet involvement (70%) with redundant leaflets (99%), and majority did not have severe regurgitation (83%).…”

“…Overall young females with redundant bileaflet prolapse had the highest risk of ventricular arrhythmias and SCD. 10 A spiked configuration of the lateral annular velocities by echocardiography is also described as a marker of risk of SCD in MVP. 11 Mitral annulus disjunction, an abnormal atrial displacement of the mitral valve leaflet hinge point, is also associated with sudden cardiac death.…”

Sympathetic nervous system and cardiovascular risk in mitral valve prolapse

“…This autonomic imbalance is hypothesized to be a crucial determinant at the beginning and also in progression of MVP. Autonomic dysregulation is an indicator of MVP pathogenesis and seems to be a very good predictor of miserable prognosis in MVP because of negative cases associated with congestive heart failure, progressive mitral insufficiency, thromboembolism, bacterial endocarditis, and even sudden cardiac death (2,17). These events, which appear at the terminal state in the course of aging, show up more frequently in patients with MVP (2).…”