The Clinical Value of Left Ventricular Strain to Predict Ventricular Arrhythmias in Mitral Valve Prolapse: a Systematic Review and Meta-analysis

Background Arrhythmic risk stratification in patients with mitral valve prolapse (MVP) is still challenging. Aims This systematic review and meta-analysis aimed to analyze the association between echocardiographic strain parameters and ventricular arrhythmias (VAs) in MVP. Methods and results Studies enlisting MVP patients, in which strain parameters were analyzed and a history of significant VAs was reported, were included. The association between myocardial deformation parameters and the occurrence of significant VAs was assessed, and strain parameters were compared between patients with significant VAs (“Arrhythmogenic mitral valve prolapse”, AMVP) vs no VAs (“Non-arrhythmogenic mitral valve prolapse”, NAMVP). Seven observational studies (1065 MVP patients) were included. Mechanical dispersion (MD) and post-systolic index (PSI) were associated with significant VAs (MD OR = 1.05, 95% CI 1.01 - 1.09, p < 0.01; PSI OR = 1.13, 95% CI 1.03 - 1.23, p < 0.01). AMVP patients showed higher MD and PSI than NAMVP patients (MD mean difference = 7.78 ms, 95% CI 2.81–12.75, p <0.01; PSI mean difference = 1.12%, 95% CI 0.53–1.72, p <0.01). GLS (global longitudinal strain) was associated with VAs in a two-study analysis (OR = 1.16, 95% CI 1.02 - 1.33, p = 0.03) and was slightly higher in AMVP (mean difference = 1.24%, 95% CI 0.33 - 2.15, p < 0.01). Conclusions MD and PSI, and to a lesser extent GLS, were associated with VAs in MVP, and differed between AMVP and NAMVP. These findings are hypothesis-generating and require validation in prospective studies before clinical application.