Prevalence, clinical significance, and risk factors of arrhythmic mitral valve prolapse — results of the MITPROL AR-PL Registry

Q: What are the key findings of this study?

Maximum leaflet thickness was an independent risk factor for arrhythmic mitral valve prolapse (OR 1.51, 95% CI 1.17-1.94, p=0.001).

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Mitral valve prolapse (n=454). Intervention: Maximum leaflet thickness vs. Lesser leaflet thickness. Primary outcome: Arrhythmic mitral valve prolapse (aMVP) (OR 1.51, 95% CI 1.17-1.94, p=0.001).

Q: What does this research mean for the field?

Arrhythmic mitral valve prolapse has a prevalence of 13.5% in the MVP population, with maximum prolapse depth and leaflet thickness serving as independent risk factors for its presence. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

K Mizia-Stec; Dominika Dziadosz; Ludmiła Daniłowicz; P Wejner - Mik; Monika Kowalczyk-Domagała; Agnieszka Boruc; Karina Wierzbowska-Drabik; Mateusz Staciwa; K Jaworski; Dorota Kustrzycka-Kratochwil; Beata Uzieblo-Zyczkowska; Danuta Sorysz; Anna Polewczyk; Barbara Brzezińska; Katarzyna Kurnicka; Jacek Bil; Olga Możeńska; Radosław Piątkowski; Piotr Duchnowski; Karolina Golińska‐Grzybała; Tomasz Kukulski; Ewa Wołoszyn-Horák; Marek Koziński; Renata Wachnicka‐Truty; Małgorzata Knapp; Klaudia Mickiewicz; Zofia Oko-Sarnowska; Michał Plewka; Ireneusz Jedliński; Małgorzata Kamela; Kamil Barański; Andrzej Gackowski; P Szymanski; J D Kasprzak

doi:10.33963/v.phj.113744

Key result

Maximum leaflet thickness linked to ~51% higher risk of arrhythmic MVP.

OR 1.51
95% CI 1.17-1.94
P=0.001
n=454

Why the study?

Mitral valve prolapse may increase ventricular arrhythmic burden, prompting an assessment of the prevalence, clinical significance, and risk factors of arrhythmic MVP in the Polish population.

Key Points

To assess the prevalence, clinical characteristics, and anatomical risk factors of arrhythmic mitral valve prolapse in a national registry cohort.
Enrolled 454 adult patients with mitral valve prolapse into the multicenter MITPROL AR-PL registry, excluding individuals with proarrhythmic comorbidities and severe mitral regurgitation to analyze a final cohort of 276 patients.
Classified patients according to the 2022 EHRA consensus into arrhythmic (aMVP, N = 61) and non-arrhythmic (non-aMVP, N = 215) groups based on transthoracic echocardiography and 24-hour Holter electrocardiogram monitoring.
Arrhythmic mitral valve prolapse was diagnosed in 61 patients (13.5%), demonstrating higher rates of Barlow's disease (52.5% vs. 25.1%, P < 0.001), bileaflet prolapse (75.4% vs. 47.9%, P < 0.001), mitral annulus disjunction (73.8% vs. 48.8%, P < 0.001), and inferior leads T-wave inversion (26.2% vs. 13.5%, P = 0.0001) compared to non-aMVP.
Multivariable logistic regression identified maximum prolapse depth (OR, 1.21; 95% CI, 1.02–1.45; P = 0.02) and leaflet thickness (OR, 1.51; 95% CI, 1.17–1.94; P = 0.001) as independent predictors of arrhythmic mitral valve prolapse.

Study Design

Type

Observational (n=454)

Multicenter

Yes

Structured PICO

P

Population

454 adult patients with mitral valve prolapse, free of severe mitral regurgitation and proarrhythmic comorbidities, evaluated for prevalence and risk factors of arrhythmic MVP.

O

Outcome

Predictors for arrhythmic mitral valve prolapse (aMVP)

Main Result

Odds Ratio: 1.51 (95% CI 1.17–1.94)

p-value: p=0.001

In patients with mitral valve prolapse without severe regurgitation or proarrhythmic comorbidities, maximum prolapse depth and leaflet thickness are independent risk factors for arrhythmic mitral valve prolapse.

Limitations

High variability and discrepancies between achieved results due to multicenter design
Registry bias
Fairly short Holter-ECG recording time (24-hour)
Did not distinguish 'true' from 'pseudo' MAD
Registry bias allowed for the analysis of the selected MVP group, and results cannot be directly compared to a general population
Fairly short Holter-ECG recording time (24-hour only)
Did not distinguish 'true' from 'pseudo' mitral annulus disjunction (MAD)

Implication

Leaflet thickness may aid arrhythmic risk stratification in MVP; leaves open whether it independently modifies outcomes or warrants intervention.

Abstract

BACKGROUND: Mitral valve prolapse (MVP) may increase ventricular arrhythmic burden. AIMS: To assess prevalence, clinical significance, risk factors of arrhythmic MVP (aMVP) of the Polish MVP population. METHODS: 454 adult MVP patients were enrolled into MITPROL AR-PL (Mitral Valve Prolapse Polish Registry). Patients with proarrhythmic comorbidities and severe mitral regurgitation were excluded. The study population was divided according to EHRA (European Heart Rhythm Association) 2022 consensus into aMVP, non-arrhythmic MVP (non-aMVP). Demographics, symptoms, electrocardiogram and MVP morphology were analyzed. RESULTS: The aMVP was diagnosed in 61 (13.5%, mean age 45.0 years, females: 46/75%) and non-aMVP in 215 (47.4%, mean age 47.9 years, females: 157/73%) patients. Differences regarding symptoms were not recorded. Comparison between aMVP and non-aMVP showed a more frequent presence of Barlow's disease (52.5 vs. 25.1%, P < 0.001), bileaflet prolapse (75.4 vs. 47.9%, P < 0.001), Pickelhaube sign (41.0 vs. 21.4%, P = 0.002), mitral annulus disjunction (MAD; 73.8 vs. 48.8%, P < 0.001), inferior leads T-wave inversion (26.2 vs. 13.5%, P = 0.0001) in the aMVP. MAD length (8.4 vs. 8.0 mm, P = 0.04), maximum prolapse depth (5.7 vs. 4.6 mm, P < 0.001), leaflet thickness (5.5 vs. 4.6 mm, P = 0.001) were higher in the aMVP. Multivariable logistic regression showed predictors for aMVP: maximum prolapse depth (OR, 1.21; CI, 1.02-1.45, P = 0.02), leaflet thickness (OR, 1.51, CI, 1.17-1.94, P = 0.001). CONCLUSIONS: The aMVP is rare. Maximum prolapse depth,leaflet thickness are independent aMVP risk factors. Screening for aMVP is reasonable in the MVP population regardless of arrhythmic symptoms with advanced prolapse, without well-recognized proarrhythmic factors.

Discussion

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Cite This Study

Mizia-Stec et al. (2026) conducted an observational in Mitral valve prolapse (n=454). Maximum leaflet thickness vs. Lesser leaflet thickness was evaluated on Arrhythmic mitral valve prolapse (aMVP) (OR 1.51, 95% CI 1.17-1.94, p=0.001). Maximum leaflet thickness was an independent risk factor for arrhythmic mitral valve prolapse (OR 1.51, 95% CI 1.17-1.94, p=0.001).

synapsesocial.com/papers/6a6302b4395161722cd16c7f https://doi.org/10.33963/v.phj.113744

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Prevalence, clinical significance, and risk factors of arrhythmic mitral valve prolapse — results of the MITPROL AR-PL Registry

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Prevalence, clinical significance, and risk factors of arrhythmic mitral valve prolapse — results of the MITPROL AR-PL Registry

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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