Mitral annulus abnormalities and an auscultatory midsystolic click may help identify patients with mitral valve prolapse who require arrhythmic risk stratification.
Mitral annulus disjunction is a constant feature of arrhythmic MVP with LV fibrosis. The excessive mobility of the leaflets caused by posterior systolic curling accounts for a mechanical stretch of the inferobasal wall and papillary muscles, eventually leading to myocardial hypertrophy and scarring. These mitral annulus abnormalities, together with auscultatory midsystolic click, may identify MVP patients who would need arrhythmic risk stratification.
Marra et al. (2016) studied this question.