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Title: | Effectiveness of the risk stratification proposed by the 2022 European Heart Rhythm Association Expert Consensus statement on arrhythmic mitral valve prolapse | Authors: | L'Hoyes, Wouter Robyns, Tomas MOURA FERREIRA, Sara De Meester, Pieter Dresselaers, Tom Herregods, Marie-Christine Rega, Filip Masci, Pier Giorgio Willems , Rik Bogaert, Jan Vandenberk, Bert |
Issue Date: | 2023 | Publisher: | MOSBY-ELSEVIER | Source: | AMERICAN HEART JOURNAL, 266 , p. 48 -60 | Abstract: | Background Recently, an expert consensus statement proposed indications where implantation of a primary prevention implantable cardioverter-defibrillator (ICD) may be reasonable in patients with mitral valve prolapse (MVP). The objective was to evaluate the proposed risk stratification by the expert consensus statement. Methods Consecutive patients with MVP without alternative arrhythmic substrates with cardiac magnetic resonance imaging (CMR) were included in a single-center retrospective registry. Arrhythmic MVP (AMVP) was defined as a total premature ventricular complex burden >= 5%, non-sustained ventricular tachycardia (VT), VT, or ventricular fibrillation. The end point was a composite of SCD, VT, inducible VT, and appropriate ICD shocks. Results In total, 169 patients (52.1% male, median age 51.4 years) were included and 99 (58.6%) were classified as AMVP. Multivariate logistic regression identified the presence of late gadolinium enhancement (OR 2.82, 95%CI 1.455.50) and mitral annular disjunction (OR 1.98, 95%CI 1.02-3.86) as only predictors of AMVP. According to the EHRA risk stratification, 5 patients with AMVP (5.1%) had a secondary prevention ICD indication, while in 69 patients (69.7%) the implantation of an ICD may be reasonable. During a median follow-up of 8.0 years (IQR 5.0-15.6), the incidence rate for the composite arrhythmic end point was 0.3%/year (95%CI 0.1-0.8). Conclusion More than half of MVP patients referred for CMR met the AMVP diagnostic criteria. Despite low long-term event rates, in 70% of patients with AMVP the implantation of an ICD may be reasonable. Risk stratification of SCD in MVP remains an important knowledge gap and requires urgent investigation. (Am Heart J 2023;266:48-60.) | Notes: | Vandenberk, B (corresponding author), Univ Hosp Leuven, Dept Cardiol, Herestr 49, B-3000 Leuven, Belgium. bert.vandenberk@uzleuven.be |
Document URI: | http://hdl.handle.net/1942/41650 | ISSN: | 0002-8703 | e-ISSN: | 1097-6744 | DOI: | 10.1016/j.ahj.2023.08.004 | ISI #: | 001074550800001 | Rights: | 2023 Elsevier Inc. All rights reserved. | Category: | A1 | Type: | Journal Contribution |
Appears in Collections: | Research publications |
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