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Circulation. Cardiovascular Imaging Jun 2024Prominent multi-scallop systolic leaflet displacement toward the left atrium (atrialization) is typically observed in bileaflet mitral valve prolapse (MVP) with mitral...
BACKGROUND
Prominent multi-scallop systolic leaflet displacement toward the left atrium (atrialization) is typically observed in bileaflet mitral valve prolapse (MVP) with mitral annular disjunction. We hypothesized that mitral leaflet atrialization is associated with an underlying left atrial (LA) myopathy characterized by progressive structural and functional abnormalities, irrespective of mitral regurgitation (MR) severity.
METHODS
We identified 334 consecutive patients with MVP, no prior atrial fibrillation, and comprehensive clinical and echocardiographic data. LA function was assessed by LA reservoir strain, LA function index, and LA emptying fraction. We also classified the stage of LA remodeling based on LA enlargement and LA reservoir strain (stage 1: no remodeling; stage 2: mild remodeling; stage 3: moderate remodeling; and stage 4: severe remodeling). The primary end point was the composite risk of sudden arrhythmic death, heart failure hospitalization, or the new onset of atrial fibrillation.
RESULTS
Bileaflet MVP with no or mild MR had a lower LA reservoir strain (=0.04) and LA function index (<0.001) compared with other MVP subtypes. In multivariable linear regression adjusted for cardiovascular risk factors and MR ≥moderate, bileaflet MVP remained significantly associated with lower LA function parameters (all <0.05). There was a significant increase in the risk of events as the LA reservoir strain and LA remodeling stage increased (<0.001). In multivariable analysis, stage 4 of LA remodeling remained significantly associated with a higher risk of events compared with stage 1 (hazard ratio, 6.09 [95% CI, 1.69-21.9]; =0.006).
CONCLUSIONS
In a large MVP registry, bileaflet involvement is associated with reduced LA function regardless of MR severity, suggesting a primary atriopathy in this MVP subtype. Abnormal LA function, particularly when assessed through a multiparametric approach, is linked to a higher risk of cardiovascular events and may improve risk stratification in MVP, even in those without significant MR.
Topics: Humans; Mitral Valve Prolapse; Female; Male; Aged; Middle Aged; Atrial Function, Left; Atrial Remodeling; Heart Atria; Atrial Fibrillation; Risk Factors; Severity of Illness Index; Retrospective Studies; Mitral Valve; Echocardiography; Mitral Valve Insufficiency; Predictive Value of Tests
PubMed: 38860362
DOI: 10.1161/CIRCIMAGING.123.016319 -
British Medical Journal (Clinical... May 1981
Topics: Adolescent; Adult; Child; Female; Heart Diseases; Humans; Male; Mitral Valve; Mitral Valve Prolapse
PubMed: 6784841
DOI: No ID Found -
Journal of Cardiology Sep 2010Although mitral valve prolapse as a disease entity has been recognized for over 50 years, its precise definition has been elusive. Initial reports based the diagnosis on... (Review)
Review
Although mitral valve prolapse as a disease entity has been recognized for over 50 years, its precise definition has been elusive. Initial reports based the diagnosis on auscultatory findings (late systolic click - murmur), with left ventricular angiography as a confirmative test. Echocardiography, first the M-mode, and subsequently the two-dimensional, became the dominant diagnostic modality. However, the early reports did not distinguish between billowing valve and flail valve. The advent of surgical repair techniques provided a different perspective; the surgical definition of mitral valve prolapse is often different from that of cardiologists. Intraoperative echocardiography gained wide acceptance necessitating a common language to describe precise terminology of the leaflet anatomy and definition of valve prolapse. The present report proposes a terminology and definitions of valve prolapse with relevance to surgical mitral valve repair. The addition of real-time 3D transesophageal echocardiography now provides highly accurate localization of lesions and the multi segment assessment of valve pathology. The etiologic considerations and surgical repair techniques with the role of echo - surgery team in improved patient outcome are described.
Topics: Echocardiography; Humans; Mitral Valve Prolapse
PubMed: 20702064
DOI: 10.1016/j.jjcc.2010.06.004 -
Heart Rhythm Feb 2016Mitral valve prolapse (MVP) is relatively common in the general population with recently reported prevalence of 1% and familial clustering (Framingham Heart Study)....
BACKGROUND
Mitral valve prolapse (MVP) is relatively common in the general population with recently reported prevalence of 1% and familial clustering (Framingham Heart Study). However, its association with ventricular arrhythmias and sudden cardiac arrest (SCA) remains controversial.
OBJECTIVES
The purpose of this study was to characterize the frequency and clinical profile of patients with MVP who suffer SCA in the community.
METHODS
Patients with SCA cases were prospectively identified in the population-based Oregon Sudden Unexpected Death Study (population ~1 million). The presence of MVP was identified from echocardiograms recorded prior but unrelated to the SCA event. The detailed clinical profile of patients with SCA and MVP was compared with that of SCA patients without MVP to identify potential differences.
RESULTS
A total of 729 SCA patients were evaluated over a 12-year period (mean age 69.5 ± 14.8 years; 64.6% men). MVP was observed in 17 (2.3%) prior to the SCA event (95% confidence interval 1.2%-3.4%). Mitral regurgitation was present in 14 SCA patients with MVP (82.3%) and was moderate or severe in 10 (58.8%). Compared with SCA patients without MVP, SCA patients with MVP were younger (mean age 60.9 ± 16.4 years vs 69.7 ± 14.7 years; P = .02), with fewer risk factors (diabetes 5.9% vs 46.4%; P = .001; hypertension 41.2% vs 78.9%; P = .001) or known coronary disease (29.4% vs 65.6%; P < .001).
CONCLUSION
MVP was observed in a small proportion (2.3%) of SCA patients in the general population, suggesting a low risk overall. Since SCA patients with MVP were characterized by younger age and relatively low cardiovascular comorbidity, a focus on imaging for valve structure/insufficiency as well as genetics could aid future risk stratification approaches.
Topics: Adult; Age Factors; Aged; Coronary Artery Disease; Death, Sudden, Cardiac; Echocardiography; Female; Humans; Hypertension; Male; Middle Aged; Mitral Valve; Mitral Valve Insufficiency; Mitral Valve Prolapse; Oregon; Prevalence; Risk Assessment; Risk Factors
PubMed: 26416619
DOI: 10.1016/j.hrthm.2015.09.026 -
Hellenic Journal of Cardiology : HJC =... 2016Mitral valve prolapse (MVP) results from the systolic movement of a portion(s) or segment(s) of the mitral valve leaflet(s) into the left atrium during left ventricular... (Review)
Review
Mitral valve prolapse (MVP) results from the systolic movement of a portion(s) or segment(s) of the mitral valve leaflet(s) into the left atrium during left ventricular (LV) systole. It should be emphasised that MVP alone, as defined by imaging techniques, may comprise a non-specific finding because it also depends on the LV volume, myocardial contractility and other LV hemodynamics. Thus, a floppy mitral valve (FMV) should be the basis for the diagnosis of MVP. Two types of symptoms may be defined in these patients. In one group, symptoms are directly related to progressive mitral regurgitation and its complications. In the other group, symptoms cannot be explained only by the degree of mitral regurgitation alone; neuroendocrine dysfunction has been implicated for the explanation of symptoms in this group of patients that today is referred as the FMV/MVP syndrome. When significant mitral regurgitation is present in a patient with FMV/MVP, surgical intervention is recommended. In patients with a prohibitive risk for surgery, transcatheter mitral valve repair using a mitraclip device may be considered. Furthermore, transcatheter mitral valve replacement may represent an option in the near future as clinical trials are underway. In this brief review, the current concepts related to FMV/MVP and FMV/MVP syndrome will be discussed.
Topics: Humans; Mitral Valve Insufficiency; Mitral Valve Prolapse; Transcatheter Aortic Valve Replacement; Treatment Outcome; Ventricular Function, Left
PubMed: 27445020
DOI: 10.1016/j.hjc.2016.03.001 -
Journal of the American College of... Jan 1986Mitral valve prolapse is probably the most common cardiac valve disorder, affecting approximately 5% of the population. Although it is genetically determined, its... (Review)
Review
Mitral valve prolapse is probably the most common cardiac valve disorder, affecting approximately 5% of the population. Although it is genetically determined, its clinical manifestations do not usually become evident before adulthood. In the setting of a cardiology referral center, a mitral valve prolapse syndrome, consisting of nonspecific symptoms, repolarization changes on the electrocardiogram and arrhythmias, has been identified. However, doubt has recently been expressed about the existence of such a syndrome. The prognosis of mitral valve prolapse is generally favorable but infrequent complications do occur and include transient ischemic attacks, progression of mitral regurgitation with or without ruptured chordae tendineae, infective endocarditis and sudden death. The symptoms and the complications are not usually related to physical activity. A permissive attitude toward participation of patients with mitral valve prolapse in competitive athletics is probably warranted; however, it would appear reasonable to disqualify athletes with mitral valve prolapse in the following circumstances: history of syncope; disabling chest pain; complex ventricular arrhythmias, particularly if induced or worsened by exercise; significant mitral regurgitation; prolonged QT interval; Marfan's syndrome; and family history of sudden death.
Topics: Adolescent; Adult; Age Factors; Chordae Tendineae; Competitive Behavior; Echocardiography; Electrocardiography; Female; Heart Auscultation; Heart Diseases; Humans; Infant, Newborn; Marfan Syndrome; Mitral Valve Prolapse; Monitoring, Physiologic; Prognosis; Risk; Rupture, Spontaneous; Sex Factors; Sports
PubMed: 3510235
DOI: 10.1016/s0735-1097(86)80286-8 -
Current Cardiology Reviews 2020The debate pertaining to the association between Keratoconus (KC) and Mitral Valve Prolapse (MVP) continues to occur among physicians. The results of cross-sectional... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
The debate pertaining to the association between Keratoconus (KC) and Mitral Valve Prolapse (MVP) continues to occur among physicians. The results of cross-sectional studies attempting to present the co-existing prevalence of these two diseases remain indeterminate. We compiled the first meta-analysis to determine the pattern of prevalence between the two diseases.
METHODS
Two separate literature searches for cross-sectional studies were performed for this metaanalysis. The first search encompassed finding literature comparing the prevalence of KC between patients with MVP and a control group. The second search pertained to finding studies comparing the prevalence of MVP patients with KC and a control group.
RESULTS
Six studies reported the prevalence of MVP in patients with KC and a control group. The prevalence was 41.6% in patients with KC and 11.5% in patients without KC (OR = 7.06 [95% CI = 2.41-20.64]). There was a significant heterogeneity among the studies (I2 = 84%). Two studies showed the prevalence of KC in patients with MVP and a control group. The prevalence was 17.0% in patients with KC and 2.9% in the control group (OR = 5.07 [95% CI = 1.08-23.83]). There was no heterogeneity within the analysis (I2 = 0%).
CONCLUSION
There is a statistically significant co-existing prevalence between MVP and KC. Patients with KC are more likely to present with MVP, and patients with MVP are more likely to present with KC.
Topics: Cross-Sectional Studies; Female; Humans; Keratoconus; Male; Mitral Valve Prolapse
PubMed: 31782369
DOI: 10.2174/1573403X15666191129100928 -
Journal of the American Heart... Aug 2022Background Idiopathic ventricular fibrillation (IVF) is diagnosed in patients with ventricular fibrillation of which the origin is not identified after extensive...
Background Idiopathic ventricular fibrillation (IVF) is diagnosed in patients with ventricular fibrillation of which the origin is not identified after extensive evaluations. Recent studies suggest an association between mitral annulus disjunction (MAD), mitral valve prolapse (MVP), and ventricular arrhythmias. The prevalence of MAD and MVP in patients with IVF in this regard is not well established. We aimed to explore the prevalence of MAD and MVP in a consecutive cohort of patients with IVF compared with matched controls. Methods and Results In this retrospective, multicenter cohort study, cardiac magnetic resonance images from patients with IVF (ie, negative for ischemia, cardiomyopathy, and channelopathies) and age- and sex-matched control subjects were analyzed for the presence of MAD (≥2 mm) and MVP (>2 mm). In total, 72 patients (mean age 39±14 years, 42% women) and 72 control subjects (mean age 41±11 years, 42% women) were included. MAD in the inferolateral wall was more prevalent in patients with IVF versus healthy controls (7 [11%] versus 1 [1%], =0.024). MVP was only seen in patients with IVF and not in controls (5 [7%] versus 0 [0%], =0.016). MAD was observed in both patients with (n=4) and without (n=3) MVP. Conclusions Inferolateral MAD and MVP were significantly more prevalent in patients with IVF compared with healthy controls. The authors advocate that evaluation of the mitral valve region deserves extra attention in the extensive screening of patients with unexplained cardiac arrest. These findings support further exploration of the pathophysiological mechanisms underlying a subset of IVF that associates with MAD and MVP.
Topics: Adult; Arrhythmias, Cardiac; Cohort Studies; Female; Humans; Male; Middle Aged; Mitral Valve; Mitral Valve Prolapse; Prevalence; Retrospective Studies; Ventricular Fibrillation
PubMed: 35929463
DOI: 10.1161/JAHA.121.025364 -
JACC. Cardiovascular Imaging Jun 2021The aim of this study was to quantitate patient-specific mitral valve (MV) strain in normal valves and in patients with mitral valve prolapse with and without...
OBJECTIVES
The aim of this study was to quantitate patient-specific mitral valve (MV) strain in normal valves and in patients with mitral valve prolapse with and without significant mitral regurgitation (MR) and assess the determinants of MV strain.
BACKGROUND
Few data exist on MV deformation during systole in humans. Three-dimensional echocardiography allows for dynamic MV imaging, enabling digital modeling of MV function in health and disease.
METHODS
Three-dimensional transesophageal echocardiography was performed in 82 patients, 32 with normal MV and 50 with mitral valve prolapse (MVP): 12 with mild mitral regurgitation or less (MVP - MR) and 38 with moderate MR or greater (MVP + MR). Three-dimensional MV models were generated, and the peak systolic strain of MV leaflets was computed on proprietary software.
RESULTS
Left ventricular ejection fraction was normal in all groups. MV annular dimensions were largest in MVP + MR (annular area: 13.8 ± 0.7 cm) and comparable in MVP - MR (10.6 ± 1 cm) and normal valves (10.5 ± 0.3 cm; analysis of variance: p < 0.001). Similarly, MV leaflet areas were largest in MVP + MR, particularly the posterior leaflet (8.7 ± 0.5 cm); intermediate in MVP - MR (6.5 ± 0.7 cm); and smallest in normal valves (5.5 ± 0.2 cm; p < 0.0001). Strain was overall highest in MVP + MR and lowest in normal valves. Patients with MVP - MR had intermediate strain values that were higher than normal valves in the posterior leaflet (p = 0.001). On multivariable analysis, after adjustment for clinical and MV geometric parameters, leaflet thickness was the only parameter that was retained as being significantly correlated with mean MV strain (r = 0.34; p = 0.008).
CONCLUSIONS
MVs that exhibit prolapse have higher strain compared to normal valves, particularly in the posterior leaflet. Although higher strain is observed with worsening MR and larger valves and annuli, mitral valve leaflet thickness-and, thus, underlying MV pathology-is the most significant independent determinant of valve deformation. Future studies are needed to assess the impact of MV strain determination on clinical outcome.
Topics: Humans; Mitral Valve; Mitral Valve Prolapse; Predictive Value of Tests; Prolapse; Stroke Volume; Ventricular Function, Left
PubMed: 33744129
DOI: 10.1016/j.jcmg.2021.01.006 -
Europace : European Pacing,... Oct 2023Patients with mitral valve prolapse (MVP) have high risk of life-threatening ventricular arrhythmias (VAs). Data on the impact of exercise on arrhythmic risk in these...
AIMS
Patients with mitral valve prolapse (MVP) have high risk of life-threatening ventricular arrhythmias (VAs). Data on the impact of exercise on arrhythmic risk in these patients are lacking. We explored whether lifetime exercise dose was associated with severe VA and with established risk factors in patients with MVP. Furthermore, we explored the circumstances at the VA event.
METHODS AND RESULTS
In this retrospective cohort study, we included patients with MVP and assessed lifetime exercise dose as metabolic equivalents of task (MET) hours/week. Severe VA was defined as sustained ventricular tachycardia or fibrillation, aborted cardiac arrest, and appropriate shock by a primary preventive implantable cardioverter defibrillator. We included 136 MVP patients (48 years [interquartile range (IQR) 35-59], 61% female), and 17 (13%) had previous severe VA. The lifetime exercise dose did not differ in patients with and without severe VA (17 MET h/week [IQR 9-27] vs. 14 MET h/week [IQR 6-31], P = 0.34). Lifetime exercise dose > 9.6 MET h/week was a borderline significant marker for severe VA (OR 3.38, 95% CI 0.92-12.40, P = 0.07), while not when adjusted for age (OR 2.63, 95% CI 0.66-10.56, P = 0.17). Ventricular arrhythmia events occurred most frequently during wakeful rest (53%), followed by exercise (29%) and sleep (12%).
CONCLUSION
We found no clear association between moderate lifetime exercise dose and severe VA in patients with MVP. We cannot exclude an upper threshold for safe levels of exercise. Further studies are needed to explore exercise and risk of severe VA.
Topics: Humans; Female; Male; Mitral Valve Prolapse; Retrospective Studies; Arrhythmias, Cardiac; Tachycardia, Ventricular; Heart Arrest
PubMed: 37851515
DOI: 10.1093/europace/euad309