Mitral valve prolapse and sudden cardiac arrest in the community

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• 作者：Kumar Narayanan ; MD^* ; Audrey Uy-Evanado ; MD^* ; Carmen Teodorescu ; MD ; PhD^* ; Kyndaron Reinier ; PhD^* ; Gregory A. Nichols ; PhD^&dagger ; ; Karen Gunson ; MD^&Dagger ; ; Jonathan Jui ; MD ; MPH^§ ; ; Sumeet S. Chugh ; MD ; FHRS^* ; ^{sumeet.chugh@cshs.org" class="auth_mail" title="E-mail the corresponding author}
• 关键词：LV ; left ventricular ; LVEF ; left ventricular ejection fraction ; MR ; mitral regurgitation ; MVP ; mitral valve prolapse ; Oregon-SUDS ; Oregon Sudden Unexpected Death Study ; SCA ; sudden cardiac arrest ; VT ; ventricular tachycardia
• 刊名：Heart Rhythm
• 出版年：2016
• 出版时间：February 2016
• 年：2016
• 卷：13
• 期：2
• 页码：498-503
• 全文大小：305 K

文摘

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.