In MVP patients, congestive heart failure independently predicts multifocal PVCs (OR 3.29), which associate with a 69.7% vs 31.1% increased risk of complex ventricular ectopy.
Are cardiovascular comorbidities associated with multifocal PVCs and complex ventricular ectopy in patients with mitral valve prolapse?
In patients with mitral valve prolapse, underlying structural heart disease, particularly congestive heart failure, is associated with multifocal PVCs and a higher risk of complex ventricular arrhythmias.
Abstract Background Multifocal premature ventricular contractions (PVCs) are associated with an increased risk of complex ventricular arrhythmias. The determinants of multifocal PVCs in patients with mitral valve prolapse (MVP) remain unclear. We hypothesized that cardiovascular comorbidities are associated with multifocal PVCs in patients with MVP. Purpose To investigate the role of cardiovascular structural and functional abnormalities in predicting multifocal PVCs and the risk of complex or frequent ventricular ectopy (cfVE) in patients with MVP. Methods We analyzed 12-lead ECGs from 191 patients with MVP to record the sites of PVC origin. Electronic medical records were queried to abstract data on cardiovascular comorbidities. Mitral regurgitation (MR) severity was assessed on transthoracic echocardiography. cfVE was defined as two or more PVCs on a single 10-second strip, or 1% PVC burden or non-sustained ventricular tachycardia (NSVT) on Holter monitoring. Results The median (IQR) age was 67 (56 – 75) years and 111 (58.1%) were females. 33 (17.3%) patients experienced multifocal PVCs. Those with multifocal PVCs were older (median age: 71 63 - 78 years vs. 66 55 - 74 years, p=0.01), had higher prevalence of atrial fibrillation (18 54.6% vs. 41 25.9%, p=0.001), coronary artery disease (10 30.3% vs. 20 12.7%, p=0.01), congestive heart failure (12 36.4% vs. 15 9.5%, p=0.0003) and moderate-to-severe MR (15 45.5% vs. 41 25.6%, p=0.03). Congestive heart failure was an independent predictor of multifocal PVCs (OR: 3.29; 1.23 - 8.74, p=0.02). Multifocal PVCs were associated with an increased arrhythmia burden (1% PVC burden on 24-hour ambulatory monitoring, 17 58.6% vs. 30 21.7%, p=0.0001) and cfVE risk (23 69.7% vs. 49 31.1%, p0.0001). Conclusion We found that in patients with MVP, underlying structural heart disease was associated with multifocal PVCs, which were, in turn, linked to a higher risk of ventricular arrhythmias. These findings suggest that MVP patients with underlying structural heart disease constitute a high ventricular arrhythmia risk subgroup.MVP patients with & w/o multifocal PVCs
Ahmad et al. (2025) studied this question. In MVP patients, congestive heart failure independently predicts multifocal PVCs (OR 3.29), which associate with a 69.7% vs 31.1% increased risk of complex ventricular ectopy.
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