Key result
Mitral valve prolapse in sudden cardiac death was associated with significantly increased annular circumference, leaflet elongation, and mitral annular disjunction compared to normal valves (P<0.001).
Why the study?
Mitral valve prolapse diagnosis at autopsy relies upon subjective assessment without established objective pathological criteria.
Do quantitative post-mortem measurements of the mitral valve differ between sudden cardiac death victims with mitral valve prolapse and normal controls?
Case-Control (n=120)
Do quantitative post-mortem measurements of the mitral valve differ between sudden cardiac death victims with mitral valve prolapse and normal controls?
Quantitative post-mortem measurements demonstrate significant structural abnormalities, including annular dilatation, leaflet thickening, and mitral annular disjunction, in sudden cardiac death victims with mitral valve prolapse.
AIMS: Mitral valve prolapse (MVP) is an accepted cause of sudden cardiac death (SCD) in most autopsy series. Diagnosis at autopsy relies upon subjective assessment with no established objective pathological criteria. This study set out to establish objective measurements to help pathologists dealing with SCD. METHODS: We diagnosed 120 (1.5%) cases of MVP in 8108 cases of SCD. We measured the mitral annulus, anterior and posterior leaflets, rough zone and mitral annular disjunction (MAD) in 27 MVP cases and compared them to 54 age- and sex-matched normal mitral valves. RESULTS: Age of death was 39 ± 16 years, with 59 females and 61 males. History of mild MV disease was present in 19 (16%). Eleven (9%) died associated with exertion. Left ventricular hypertrophy was present in nine (15%) females and 10 (16%) males. Both MV leaflets showed thickening and ballooning in all individuals. MVP showed highly significantly increased annular circumference, elongation and thickening of both leaflets as well as increased MAD (all P < 0.001). Left ventricular fibrosis was present in 108 (90%), with interstitial fibrosis in the posterolateral wall and papillary muscle in 88 (81%) and coexisting replacement fibrosis in 40 (37%). CONCLUSION: This is the largest MVP associated with SCD series highlighting a young cohort with equal representation of males and females. There is involvement of both leaflets with significant annular dilatation, elongation and thickening of both leaflets with MAD. Left ventricular fibrosis explains arrhythmia. Our quantitative measurements should serve as a reference for pathologists assessing post-mortem hearts for MVP.
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Westaby et al. (2024) conducted a case-control in Mitral valve prolapse and sudden cardiac death (n=120). Mitral valve prolapse vs. Age- and sex-matched normal mitral valves was evaluated on Mitral valve measurements (annular circumference, leaflet elongation and thickening, and mitral annular disjunction) (p=<0.001). Mitral valve prolapse in sudden cardiac death was associated with significantly increased annular circumference, leaflet elongation, and mitral annular disjunction compared to normal valves (P<0.001).
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