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

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. 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. 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. 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. [ABSTRACT FROM AUTHOR]