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High-risk phenotypes of arrhythmic mitral valve prolapse: a systematic review and meta-analysis.

Authors :
Benjanuwattra J
Kewcharoen J
Phinyo P
Swusdinaruenart S
Abdelnabi M
Del Rio-Pertuz G
Leelaviwat N
Navaravong L
Source :
Acta cardiologica [Acta Cardiol] 2023 Nov; Vol. 78 (9), pp. 1012-1019. Date of Electronic Publication: 2023 Jun 26.
Publication Year :
2023

Abstract

Background: Mitral valve prolapse (MVP) is associated with aggravated risk of ventricular tachycardia (VT), ventricular fibrillation (VF) and sudden cardiac death (SCD). There is a lack of specific guideline recommendation regarding risk stratification and management, despite multiple proposed high-risk phenotypes. We performed systematic review and meta-analysis to evaluate high-risk phenotypes for malignant arrhythmias in patients with MVP.<br />Methods: We comprehensively searched the databases of MEDLINE, SCOPUS, and EMBASE from inception to April 2023. Included studies were cohort and case-control comparing between MVP patients with and without VT, VF, cardiac arrest, ICD placement, or SCD. Data from each study were combined using the random-effects. Pooled odds ratios (OR) and 95% confidence intervals (CI) were calculated.<br />Results: Nine studies from 1985 to 2023 were included involving 2,279 patients with MVP. We found that T-wave inversion (OR 2.52; 95% CI: 1.90-3.33; p  < 0.001), bileaflet involvement (OR 2.28; 95% CI: 1.69-3.09; p  < 0.001), late gadolinium enhancement (OR 17.05; 95% CI: 3.41-85.22; p  < 0.001), mitral annular disjunction (OR 3.71; 95% CI: 1.63-8.41; p  < 0.002), and history of syncope (OR 6.96; 95% CI: 1.05-46.01; p  = 0.044), but not female (OR 0.96; 95% CI: 0.46-2.01; p  = 0.911), redundant leaflets (OR 4.30; 95% CI: 0.81-22.84; p  = 0.087), or moderate-to-severe mitral regurgitation (OR 1.24; 95% CI: 0.65-2.37; p  = 0.505), were associated with those events.<br />Conclusion: Bileaflet prolapse, T-wave inversion, mitral annular disjunction, late gadolinium enhancement, and history of syncope are high-risk phenotypes among population with MVP. Further research is needed to validate the risk stratification model and justify the role of primary prophylaxis against malignant arrhythmias.

Details

Language :
English
ISSN :
1784-973X
Volume :
78
Issue :
9
Database :
MEDLINE
Journal :
Acta cardiologica
Publication Type :
Academic Journal
Accession number :
37358248
Full Text :
https://doi.org/10.1080/00015385.2023.2227487