Objective Mitral valve prolapse (MVP) has been associated with ventricular arrhythmias (VA), but little is known about VA in patients with significant primary mitral regurgitation (MR). Our aim was to describe the prevalence of symptomatic VA in patients with MVP (fibro-elastic deficiency or Barlow’s disease) referred for mitral valve (MV) surgery because of moderate-to-severe MR, and to identify clinical, electrocardiographic, standard and advanced echocardiographic parameters associated with VA.
Methods 610 consecutive patients (64±12 years, 36% female) were included. Symptomatic VA was defined as symptomatic and frequent premature ventricular contractions (PVC, Lown grade ≥2), non-sustained or sustained ventricular tachycardia (VT) or ventricular fibrillation (VF) without ischaemic aetiology.
Results A total of 67 (11%) patients showed symptomatic VA, of which 3 (4%) had VF, 3 (4%) sustained VT, 27 (40%) non-sustained VT and 34 (51%) frequent PVCs. Patients with VA were significantly younger, more often female and showed T-wave inversions; furthermore, they showed significant MV morphofunctional abnormalities, such as mitral annular disjunction (39% vs 20%, p<0.001), and dilatation (annular diameter 37±5 mm vs 33±6 mm, p<0.001), lower global longitudinal strain (GLS 20.9±3.1% vs 22.0±3.6%, p=0.032) and prolonged mechanical dispersion (45±12 ms vs 38±14 ms, p=0.003) as compared with patients without VA. Female sex, increased MV annular diameter, lower GLS and prolonged mechanical dispersion were identified as independent associates of symptomatic VA.
Conclusion In patients with MVP with moderate-to-severe MR, symptomatic VA are relatively frequent and associated with significant MV annular abnormalities, subtle left ventricular function impairment and heterogeneous contraction. Assessment of these parameters might help decision-making over further diagnostic analyses and improve risk-stratification.
- mitral regurgitation
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Contributors All authors contributed to the conception and the design of the study. ALvW, MdR, YLH, PvdB and NAM contributed to acquisition of the data. ALvW, FF and NAM analysed the data, all authors contributed to interpretation of the data. Drafting of the manuscript was done by ALvW and NAM, the manuscript was critically revised by MdR, FF, PvdB, JJB and VD. Finally, all authors gave final approval and agreed to be accountable for all aspects of the work ensuring integrity and accuracy.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests The Department of Cardiology received unrestricted research grants from Abbott Vascular, Bayer, Bioventrix, Biotronik, Boston Scientific, Edwards Lifesciences, GE Healthcare and Medtronic. VD received speaker fees from Abbott Vascular, Edwards Lifesciences, GE Healthcare and Medtronic. NAM received speakers fees from Abbott Vascular and GE Healthcare. JJB received speaker fees from Abbott Vascular. The remaining authors have nothing to disclose.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Patient consent for publication Not required.
Ethics approval The study was approved by the Institutional Review Board and Medical Ethical Committee of the Leiden University Medical Center. The study complies with the Declaration of Helsinki. The Institutional Review Board and Medical Ethical Committee waived the need of written informed consent for this retrospective analysis of clinical data acquisition.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data are available on reasonable request.