Analysis of cardiovascular clinical-morphological predictors associated with ventricular arrhythmia in mitral valve prolapse

Abstract

INTRODUCTION: Mitral valve prolapse (MVP) is the most common valvular heart disease, affecting approximately 2-3% of the general population. While the prognosis is largely benign in the absence of mitral regurgitation, a small but poorly defined subgroup of individuals remains at increased risk of malignant ventricular arrhythmias and sudden death.

OBJETIVE: To analyze clinical-echocardiographic predictors associated with ventricular arrhythmic burden in asymptomatic patients, who were diagnosed as having PVM in routine studies in our environment.

 MATERIAL AND METHODS: Observational, retrospective and analytical study. Asymptomatic patients with PVM, diagnosed by Doppler echocardiography, were included in relation to the ventricular arrhythmic load assessed by 24-h Holter monitoring, between April 2021 and November 2022. Rare ventricular arrhythmic load was considered < 3% of the total complexes. in 24 hours and frequent ventricular arrhythmia when ≥ 3% of the total complexes were found in 24 hours. The variables analyzed were quantitative (age) and qualitative (sex, diastolic diameter of the dilated left ventricle, presence of dilated left atrium, degree of mitral insufficiency, type of mitral valve prolapse and ventricular arrhythmic load). Statistical analysis: position and dispersion measures were used for continuous variables, while qualitative variables were described through absolute and relative frequencies. To study the relationship between the variables of interest, the chi-square test was used and a significant value of p ≤ 0.05 was considered

RESULTS: The sample consisted of 122 patients; 79 were female (64.8%). The patients had a mean age ± standard deviation of 45.9 ± 9.3 years. A greater ventricular arrhythmic burden was observed in patients >50 years of age (p = 0.02), with moderate-severe mitral regurgitation (p <0.001) and dilated left atrium (p <0.001). No differences were observed in the frequency of ventricular arrhythmic load according to sex (p = 0.21), dilated diastolic diameter of the left ventricle (p 0.09) and according to the type of mitral valve prolapse (p = 0.21). 27).

CONCLUSIONS: PVM is considered a pathology that represents a low overall risk of cardiovascular mortality due to ventricular arrhythmia. In this study, three variables were found associated with the development of said arrhythmia, such as the presence of left atrial enlargement, moderate-severe mitral insufficiency and age over 50 years. These indicators would allow the identification of individuals at higher risk of suffering a cardiovascular event or death.