In patients with mitral valve prolapse, PVC burden ≥5% was significantly associated with disproportionate left ventricular remodelling beyond MR volume load (p=0.022).
Does the presence of ventricular arrhythmias affect left ventricular remodelling in patients with mitral valve prolapse beyond mitral regurgitation volume load?
Frequent ventricular arrhythmias, particularly a PVC burden >=5%, are associated with disproportionate left ventricular remodelling in patients with mitral valve prolapse, independent of mitral regurgitation volume.
Absolute Event Rate: 0% vs 0%
Abstract Background Mitral valve prolapse (MVP) is a common valvular disorder and the most frequent cause of primary mitral regurgitation (MR). While left ventricular (LV) dilatation in patients with MVP usually occurs as a result of significant volume overload, LV remodelling has been observed to be disproportionate to the degree of MR, which has led to the hypothesis of an MVP cardiomyopathy. Furthermore, LV fibrosis and associated ventricular arrhythmias (VA) are known to be malignant features associated with MVP, which could potentially induce LV dilatation and dysfunction beyond other risk factors. Purpose To investigate whether the presence of VA affects LV remodelling in MVP patients beyond MR volume load and other known risk factors. Methods Consecutive patients with non-syndromic MVP were prospectively included. All patients underwent CMR scan (1.5T) and 24h Holter monitoring. All LV volumes were calculated from CMR short-axis stack images and indexed for body surface area. MR volume was calculated using CMR as the difference between total LV stroke volume and aortic forward stroke volume. Disproportionate LV remodelling was defined as LV dilatation over the age- and gender-specific upper limit of normal, after correction for MR volume. Presence of VA (nonsustained ventricular tachycardia (VT) and PVC burden) was assessed using 24h Holter. Results A total of 65 patients with MVP were included (63% males, age 57 ± 15 years), including 43 with Barlow’s disease (BD) versus 22 with fibroelastic deficiency. Disproportionate LV remodelling was observed in 27 patients (42%). Patients with disproportionate LV remodelling had a significantly higher PVC burden (42% vs. 14% with PVC =1%, p=0.015; and 16% vs. 0% with PVC =5%, p=0.022) compared to non-disproportionate LV remodelling, but nonsignificant difference in the presence of nonsustained VT (19% vs. 8%, p=0.257). Furthermore, the presence of late gadolinium enhancement (LGE) was similar in patients with disproportionate versus non-disproportionate LV remodelling (59% vs 63%, p=0.75). However, all patients with VT had myocardial LGE compared to 56% of patients without VT (p=0.020). Multiple linear regression analysis showed that besides age, male gender and total MR volume load, also BD subtype and PVC burden =5% were significant predictors of indexed LV end-diastolic volume. Conclusion Frequent VA, especially PVC burden =5%, in patients with MVP is associated with LV remodelling disproportionate to the consequence of MR volume load, and beyond other known risk factors like age, gender and MVP subtype.Multiple linear regression model
Pype et al. (Thu,) reported a other. In patients with mitral valve prolapse, PVC burden ≥5% was significantly associated with disproportionate left ventricular remodelling beyond MR volume load (p=0.022).