Key result
Ventricular arrhythmias occur in ~22% of MVP patients, with age linked as the sole predictor.
Why the study?
Mitral valve prolapse can predispose to arrhythmia across diverse phenotypes and proarrhythmic comorbidities, but the prevalence and clinical significance of ventricular arrhythmia in this population required assessment.
Primary arrhythmic mitral valve prolapse and MVP with proarrhythmic comorbidities represent distinct clinical phenotypes, with age being the only independent predictor for ventricular arrhythmia in the comorbidity group.
Supports arrhythmia monitoring in older comorbid MVP patients; leaves open whether arrhythmic phenotypes warrant distinct risk stratification.
Introduction Mitral valve prolapse (MVP) is a primary structural defect that can predispose for arrhythmia. MVP population is diverse, apart from the rare, primary arrhythmic (aMVP), and non-arrhythmic (non-aMVP) phenotype, there are patients with MVP and proarrhythmic comorbidities, including severe mitral regurgitation (MR). Those subgroups differ from each other regarding demographics, symptoms, MVP morphology and outcome. Purpose To assess prevalence and clinical significance of ventricular arrhythmia (VA) among wide-age spectrum MVP Polish population. Methods 454 MVP patients (mean age 53.7 years, females 267/58.8%) were enrolled into the prospective observational registry MITPROL AR-PL of the Polish Cardiac Society carried out in tertiary cardiology reference centers. The studied population was divided based on the EHRA 2022 consensus into aMVP (mean age 45.0 years, females 46/75%), non-aMVP (mean age 47.9 years, females 157/73%) and MVP C+A (comorbidities+ arrhythmia) (mean age 66.8 years, females 18/48%), MVP C+ (comorbidities without arrhythmia) (mean age 66.2 years, females 46/33.3%) groups. Parameters like age, gender, symptoms, ECG abnormalities, MVP morphology were included in the risk factor analysis for the occurrence of VA between the aMVP and MVP C+A and age-divided subgroups: young adults (18-45 yrs.), middle-aged (46-59 yrs.), elderly (60+ yrs.). Results Among MITPROL AR-PL population there were 101 (22.3%) subjects fulfilling arrhythmic EHRA consensus criteria: 61 (13.5%) in aMVP and 40 (8.8%) in MVP C+A group. Following differences between aMVP and MVP C+A groups were observed: mean age (45.0 vs 66.8 years, p<0.001), females (75% vs 48%, p=0.001), age subgroups (young adults 56% vs 10%, middle-aged 20% vs 15%, elderly 24% vs 75%, p<0.001), maximum leaflet thickness (5.5±1.9mm vs 4.58±1.6mm, p=0.02), MVP type (bileaflet 75.4% vs 42.5%, anterior 3.3% vs 40.0%, posterior 21.3% vs 17.5%, p<0.001), Pickelhaube sign (41.0% vs 22.5%, p=0.05), MAD (73.8% vs 47.5%, p=0.001), moderate MR (49.2% vs 30%, p<0.0001), heart failure-NYHA class (I 82.0% vs 37.5%, II 18% vs 35%, III 0% vs 25%, IV 0% vs 2.5%, p<0.0001), comorbidities (hypertension 16.4% vs 55.0%, p<0.0001; chronic kidney disease 0% vs 15%, p=0.001), T wave inversion in V1-V6 leads (13.1% vs 35.0%, p=0.009). There were no differences regarding MVP morphology (Barlow’s Disease, Forme Fruste, Fibroelastic deficiency), MVP depth, clinical (severity, occurrence, syncope) symptoms of arrhythmia and type of VA on ECG monitoring. Multivariate logistic regression revealed that only age was a predictor for VA in the MVP A+C group (OR 1.1, CI 1.05-1.2). Conclusion Although VA occurs in aMVP and MVP C+A groups, those patients differ from each other. Primary aMVP is characterized by younger age, female gender, thickening of the mitral leaflets, MAD, Pickelhaube sign. Symptoms of heart failure, comorbidities, male gender, and advanced age are related to the MVP A+C group.
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Dziadosz et al. (2025) studied this question. Ventricular arrhythmias occurred in 22.3% of MVP patients, with age being the only multivariate predictor (OR 1.1, CI 1.05-1.2) in those with arrhythmias and comorbidities.
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