Studies have suggested that some patients with mitral valve prolapse are potentially at higher risk of sudden cardiac death. Current thinking suggests that there may exist a 'malignant' subtype of mitral valve prolapse, such as bileaflet prolapse with associated complex ventricular arrhythmias which could be linked with increased risk of sudden cardiac death.
To study if there is a correlation between the types of mitral valve prolapse (MVP) and ventricular arrhythmias, including premature ventricular contractions (PVCs).
A cross-sectional study evaluating patients at UCLA Medical Center diagnosed with any degree of MVP with available Holter monitor data.
The study included patients from the UCLA Echocardiography Lab database with the diagnosis of mitral valve prolapse. The diagnosis was confirmed by review of the echocardiogram report. All patients with MVP and available Holter data were included in a database for analysis. Information regarding the characteristics of MVP and PVC burden was extracted from the patient's charts in CareConnect and stored in a secured excel database. The patients were divided into three groups: 1. Mitral valve bowing, but no prolapse, 2. Single leaflet prolapse, and 3. Bileaflet prolapse. Variables analyzed included: degree of mitral regurgitation (MR), Lown classification of PVC type, PVC burden, number of PVC morphologies and ventricular tachycardia burden. The collected data was then summarized in a table and analyzed using Chi-Square analysis for any significant correlation.
A total of 288 patients were evaluated for degree of MVP and associated PVC burden. We found that moderate and severe MR were more in the MVP (single and double leaflet) group than in the ‘bowing no prolapse’ group (p<0.01). PVCs with alternating couplet morphology and ventricular triplets were more in the MVP (single and double leaflet) group than the ‘bowing no prolapse’ group (p= 0.05 and p= 0.03 respectively). There was no difference observed for the PVC burden and ventricular tachycardia burden among the three groups.
The MVP group experienced more moderate and severe MR as well as more PVCs with alternating couplet morphology and ventricular triplets than the ‘bowing no prolapse’ group. There was no difference in PVC burden or ventricular tachycardia between the MVP groups, as compared to the ‘bowing no prolapse’ group.