Arrhythmic MVP occurs in 13.5% of MVP patients and is independently predicted by increased maximum prolapse depth (HR 1.21) and leaflet thickness (HR 1.51).
What are the prevalence and independent risk factors for arrhythmic mitral valve prolapse in patients without severe mitral regurgitation or proarrhythmic comorbidities?
In a Polish registry of MVP patients without severe regurgitation or proarrhythmic comorbidities, arrhythmic MVP was present in 13.5% of the total cohort, with maximum prolapse depth and leaflet thickness identified as independent risk factors.
Abstract Introduction Mitral valve prolapse (MVP) is a heterogenous, primary structural defect that can predispose for arrhythmia. The role of MVP as a substrate of ventricular arrhythmias isn’t well documented. Purpose To assess prevalence, clinical significance, and risk factors of aMVP among wide-age spectrum MVP Polish population. Methods 454 MVP patients (mean age 53.7 years, females 267/58.8%) were enrolled into the prospective observational registry MITPROL AR-PL of the Polish Cardiac Society carried out in tertiary cardiology reference centers. Patients with severe mitral regurgitation (MR), proarrhythmic comorbidities (N=178, mean age 63.6 years, females 64/36%) were excluded. The study population (N=276, mean age 47.3 years, females 203/73.6%) was divided based on the EHRA 2022 consensus into: aMVP, non-arrhythmic MVP (non-aMVP) and analyzed as the total population and age subgroups: young adults (18-45 yrs.), middle-aged (46-59 yrs.), elderly (60+ yrs.). Parameters like age, gender, symptoms, ECG abnormalities, MVP morphology were included in the aMVP risk factor analysis. Results aMVP was diagnosed in 61 (13.5%, mean age 45.0 years, females 46/75%) and non-aMVP in 215 (47.4%, mean age 47.9 years, females 157/73%) patients. There was a difference in aMVP age distribution: young adults- 56%, middle-aged- 20%, elderly- 24% (p=0.01). There were no differences regarding symptoms of arrhythmia between groups. T-wave inversion (TWI) in the inferior leads was associated with aMVP (26.2% vs 13.5%, p=0.0001). The comparison of MVP morphology between aMVP and non-aMVP showed more frequent presence of: Barlow’s Disease (52.5 % vs 25.1%, p0.001), bileaflet prolapse (75.4% vs 47.9%, p0.001), Pickelhaube sign (41.0% vs 21.4%, p=0.002), MAD (73.8% vs 48.8%, p0.001). MAD diameter (8.4 ± 2.5 mm vs. 8.0 ± 3.8 mm, p=0.04), maximum prolapse depth (5.7 ± 2.3 mm vs 4.6 ± 1.8, p0.001), and maximum leaflet thickness (5.5 ± 1.9 mm vs 4.6 ± 1.1, p=0.001) were higher in the aMVP vs non-aMVP. A univariate analysis showed following variables to be related to aMVP: hypertension (OR 0.46, CI 0.22-0.96, p=0.04), TWI in the inferior leads (OR 2.28, CI 1.14-4.55, p=0.01), maximum prolapse depth (OR 1.27, CI 1.11-1.46, p=0.0003), maximum leaflet thickness (OR 1.54, CI 1.25-1.89, p0.0001), Barlow’s Disease (OR 3.16, CI 1.72-5.80, p=0.0009), bileaflet prolapse (OR 8.03, CI 1.85-34.81, p=0.0004), Pickelhaube sign (OR 2.53, CI 1.38-4.64, p=0.002), MAD (OR 3.42, CI 1.71-6.86, p=0.0005). Multivariate logistic regression revealed predictors for aMVP: maximum prolapse depth (HR 1.21; CI 1.02-1.45, p=0.02), maximum leaflet thickness (HR 1.51, CI 1.17 – 1.94, p=0.001). Conclusion Primary aMVP variant is rare, 13.5% of all patients fulfill the criteria of aMVP. Its evaluation needs exclusion of severe MR and proarrhythmic comorbidities. Complex clinical analysis is necessary. Only the maximum prolapse depth and leaflet thickness are independent risk factors for aMVP.MVP morphology Mitprol AR-PL Population
Mizia-Stec et al. (2025) studied this question. Arrhythmic MVP occurs in 13.5% of MVP patients and is independently predicted by increased maximum prolapse depth (HR 1.21) and leaflet thickness (HR 1.51).