QT dispersion in patients with mitral valve prolapse is related to the echocardiographic degree of the prolapse and mitral leaflet thickness

Zouridakis, Emmanouil; Parthenakis, F.; Kochiadakis, Georgios E.; Kanoupakis, Emmanuel M.; Vardas, Panos

doi:10.1053/eupc.2001.0186

Cited by 34 publications

(27 citation statements)

References 36 publications

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“…In studies involving adults, a close relation between ventricular arrhythymias and QT dispersion which is a criterion for regional differences in the ventricular repolarization period has been reported (7)(8)(9). In the study of Kulan et al (7) which involved 64 adult patients with primary MVP and 80 healthy individuals, it was shown that QT dispersion increased in the patient group and there was a correlation between the increase in QT dispersion and complex ventricular arrhythymias.…”

Section: Discussionmentioning

confidence: 93%

“…In studies involving adults, the frequency of ventricular arrhythmia in patients with primary MVP has been reported with a rate ranging between 49% and 89% depending on the patient group and MVP diagnostic criteria (21)(22)(23) Various causes have been proposed in formation of ventricular arrhythmias in primary MVP. These include stretching of the papillary muscles with ballooning prolapse of mitral leaflets (27), mechanical stimulation of the endocardium by thickened chordate (28), coronary emboly caused by accumulation of platalets and fibrin as a result of endocardial friction (29), autonomic dysfunction (30,31) and repolarization changes characterized by prolongation in QT interval and increase in QT dispersion (7)(8)(9).…”

Section: Discussionmentioning

confidence: 99%

“…It is thought that QT dispersion reflects regional differences in ventricular repolarization. In studies involving adults, it has been proposed that increased QT dispersion in patients with MVP is associated with ventricular arrhythmias, but QT length is not associated with ventricular arrhythmias (7)(8)(9). Heart rate variation examination is a method which is measured on 24-hour rhythm Holter monitoring and used in evaluation of the autonomic functions of the heart (10,11).…”

Section: Introductionmentioning

confidence: 99%

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QT dispersion and ventricular arrhythmias in children with primary mitral valve prolapse

İmamoğlu

Eroğlu

2016

Turk Pediatri Ars

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Aim: To investigate ventricular arrhythmias in children with primary mitral valve prolapse and to evaluate its relation with QT length, QT dispersion, autonomic function tests and heart rate variability measurements. Material and Methods:Fourty two children with mitral valve prolapse and 32 healthy children were enrolled into the study. Twelve-lead electrocardiograms, autonomic function tests, echocardiography and 24-hour rhythm Holter tests were performed. Electrocardiograms were magnified digitally. The QT length was corrected according to heart rate. The patients were grouped according to the number of premature ventricular contractions and presence of complex ventricular arhythmia in the 24-hour rhythm Holter monitor test. Heart rate variability measurements were calculated automatically from the 24-hour rhythm Holter monitor test. Orthostatic hypotension and resting heart rate were used as autonomic function tests. Results:The mean age was 13.9±3.3 years in the patient group and 14.6±3.1 years in the control group (p>0.05). Thirty four of the patients (81%) were female and eight (19%) were male. Twenty five of the control subjects (78%) were female and seven (22%) were male. The QT dispersion and heart rate corrected QT interval were found to be significantly increased in the children with primary mitral valve prolapse when compared with the control group (56±16 ms vs. 43±11 ms, p=0.001; 426±25 ms vs. 407±26 ms, p=0.002, respectively). In 24-hour rhythm Holter monitor tests, ventricular arrhythmias were found in 21 out of 42 patients (50%) and 6 out of 32 control subjects (18.8%) (p=0.006). QT dispersion was found to be significantly increased in patients with premature ventricular contractions ≥ 10/day and/or complex ventricular arrhythmias compared to the control group without ventricular premature beats (p=0.002). There was no significant difference in autonomic function tests and heart rate variability measurements between the patient and control groups. Conclusions:The noted increase in QT dispersion may be a useful indicator for the clinician in the evaluation of impending ventricular arrhythmias in children with primary mitral valve prolapse. (Turk Pediatri Ars 2016; 51: 135-41)

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Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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QT dispersion and ventricular arrhythmias in children with primary mitral valve prolapse

İmamoğlu

Eroğlu

2016

Turk Pediatri Ars

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“…Zouridakis et al showed that patients with increased anterior mitral leaflet thickness were more likely to develop complex ventricular arrhythmias [24]. In addition, Nishimura et al reported that an increased mitral leaflet thickness was the only independent variable associated with sudden death in MVP patients [12].…”

Section: Discussionmentioning

confidence: 98%

Predictors of ventricular arrhythmias in patients with mitral valve prolapse

Türker

Özaydın

Acar

et al. 2009

Int J Cardiovasc Imaging

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Arrhythmias have been reported to occur frequently in symptomatic patients with mitral valve prolapse (MVP). The mechanisms causing ventricular arrhythmias in patients with MVP have not been fully investigated. The purpose of this study was to determine the clinical, echocardiographic and heart rate variability parameters, and plasma concentrations of electrolytes and inflammatory markers in predicting ventricular arrhythmias in patients with MVP. A total of 58 consecutive patients with MVP were included in this study. We performed electrocardiography, echocardiography, holter analysis, routine biochemical tests including plasma concentrations of electrolytes and inflammatory markers, and evaluated the clinical characteristics. Ventricular arrhythmia defined as occurrence of any of the followings: ventricular premature contractions (VPCs), VPC couplets, and ventricular tachycardia documented by holter analysis, continuous monitoring or by electrocardiography. Twenty patients (34%) had ventricular arrhythmias, and 38 (66%) patients had no ventricular arrhythmias. Seventeen patients had VPC, 2 patients had VPC couplets and 1 patient had ventricular tachycardia. Univariable predictors of ventricular arrhythmias included isovolumetric relaxation time and the occurrence of moderate to severe mitral regurgitation. Multivariable logistic regression analysis showed that occurrence of moderate to severe mitral regurgitation was the only independent predictor of ventricular arrhythmias (relative risk: 8.42, 95% confidence interval: 1.49-47.64, p = 0.01). Present study showed that the only independent predictor of ventricular arrhythmias in patients with MVP is the occurrence of moderate to severe mitral regurgitation.

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“…Several reports showed alterations in ventricular repolarization, such as increased QT and QTc dispersions, in MVP patients [29,30]. In addition, the prolongation of QT dispersion was found to be associated with the degree of prolapse and thickness of the leaflets [31]. In a study of pediatric patients, QT dispersion values [55 ms were found to be more likely in cases of primary MVP than in cases of rheumatic MVP [24].…”

Section: Discussionmentioning

confidence: 95%

Prolonged Tp–e Interval and Tp–e/QT Ratio in Children with Mitral Valve Prolapse

et al. 2016

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Although it is considered to be a benign condition, previous studies have shown that a subset of patients with mitral valve prolapse (MVP) may be at risk of ventricular arrhythmia and sudden cardiac death (SCD). Previous studies have suggested that the interval between the peak and the end of the T wave (Tp-e) can be used as a marker for the transmural dispersion of repolarization. Increased Tp-e interval and Tp-e/QT ratio are associated with ventricular arrhythmias and SCD. The aim of this study was to assess alterations in ventricular repolarization by using the Tp-e interval and Tp-e/QT ratio in children with MVP and to investigate their relationships with the degree of valvular regurgitation. This study prospectively investigated 110 children with MVP and 107 age- and sex-matched healthy control subjects. Tp-e interval, Tp-e/QT ratio, and QT and QTc dispersions were measured from a 12-lead electrocardiogram and compared between groups. QT and QTc dispersions, Tp-e interval, and Tp-e/QTc ratio were found to be significantly higher in patients with MVP. A positive correlation was found between Tp-e/QTc ratio and increase in the degree of mitral regurgitation (MR) (p < 0.05; r = 0.2). However, the degree of MR was not associated with QT, QTc, or Tp-e intervals; QT, QTc, or Tp-e dispersions; or Tp-e/QT ratio (all p values >0.05). Individuals with MVP may be more prone to ventricular arrhythmias due to prolonged QTd, QTcd, and Tp-e interval and increased Tp-e/QT and Tp-e/QTc ratios. Therefore, due to their longer life expectancy, children with MVP should be followed up on regarding life-threatening arrhythmias.

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QT dispersion in patients with mitral valve prolapse is related to the echocardiographic degree of the prolapse and mitral leaflet thickness

Abstract: Our results indicate that QT and JT dispersions are related to the echocardiographic degree of MVP and mitral leaflet thickness. The echocardiographic assessment of the severity of the prolapse may help to identify a subgroup of patients at increased risk of life-threatening arrhythmias.

Cited by 34 publications

References 36 publications

QT dispersion and ventricular arrhythmias in children with primary mitral valve prolapse

QT dispersion and ventricular arrhythmias in children with primary mitral valve prolapse

Predictors of ventricular arrhythmias in patients with mitral valve prolapse

Prolonged Tp–e Interval and Tp–e/QT Ratio in Children with Mitral Valve Prolapse

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