Author + information
- Brian Fulton,
- Jackson Liang and
- Yuchi Han
Background: While mitral valve prolapse is typically thought to be benign, recent studies have suggested increased risk of ventricular arrhythmias. We aimed to examine whether certain cardiac imaging characteristics may be associated with increased risk of ventricular arrhythmias in patients with mitral valve prolapse.
Methods: We screened electronic medical records of all patients documented to have mitral valve prolapse on either transthoracic echocardiography (TTE) or cardiac magnetic resonance imaging (CMR), who also underwent an electrophysiologic study (EPS) between 2007 and 2016. For TTE, both anterior and posterior mitral leaflet thickness and prolapsed distance were measured. For CMR, the presence of late gadolinium enhancement in the region of the papillary muscles was assessed. For the EPS, patients were categorized as papillary muscle focus positive (pap(+)) or negative (pap(-)). The TTE and CMR data were then cross-referenced with three-dimensional electroanatomic maps to assess predictors of the location of arrhythmogenic foci.
Results: Eighteen patients (14 women, mean age 48.7 years; mean left ventricular ejection fraction 53.69%) with mitral valve prolapse who underwent EPS for mapping/ablation of ventricular arrhythmias were included in this study. Both TTE and CMR studies were available for review in 4 patients, TTE only in 11, and CMR only in 3. Of the 15 patients who underwent TTE, a significantly higher proportion of patients in the pap(+) group had an anterior to posterior leaflet prolapse ratio of >0.45 (8/8 vs. 3/7, p = 0.026). There were no differences in anterior or posterior leaflet thickness or prolapse distance between groups. Patients in the pap(+) group were more likely to be women (8/8 vs. 3/7, p = 0.026). Of the 7 patients who underwent CMR those who were pap(+) were more likely to have late gadolinium enhancement in the region of the papillary muscles than those who were pap(-) (5/5 vs. 0/2, p=0.048).
Conclusions: Female gender, anterior to posterior leaflet prolapse ratio >0.45 on TTE, and presence of papillary muscle late gadolinium enhancement on CMR may be associated with papillary muscle origin of ventricular arrhythmias in patients with mitral valve prolapse.
Poster Hall, Hall C
Friday, March 17, 2017, 10:00 a.m.-10:45 a.m.
Session Title: Fibrillatory Arrhythmias: Outcomes With Contemporary Practice
Abstract Category: 8. Arrhythmias and Clinical EP: Supraventricular/Ventricular Arrhythmias
Presentation Number: 1110-105
- 2017 American College of Cardiology Foundation