Usefulness of Cardiac Magnetic Resonance Images for Prediction of Sudden Cardiac Arrest in Patients with Mitral Valve Prolapse: A Multicenter Retrospective Cohort Study

Abstract

Background: An association has been identified between mitral valve prolapse (MVP) and sudden cardiac arrest (SCA), and ventricular arrhythmias (VA). This study aimed to elucidate risk factors for SCA or VA in MVP patients.Methods: MVP patients who had undergone cardiac magnetic resonance (CMR) were retrospectively included. Patients with other structural heart disease or causes of aborted SCA were excluded. Clinical characteristics (sex, age, body mass index, histories of diabetes, hypertension, coronary artery disease, and dyslipidemia), electrocardiographic (PR interval, QRS duration, corrected QT interval, bundle branch block, and atrial fibrillation), echocardiographic [mitral regurgitation grade, prolapsing mitral leaflet, and right ventricular systolic pressure (RVSP)] and CMR [both ventricular ejection fractions, both ventricular end-diastolic and systolic volume indexes, presence of late gadolinium enhancement (LGE), LGE volume and proportion] parameters were analyzed.Results: Of the 85 patients [age, 55.0 (41.0–65.0) years; 46 men] included, 7 experienced SCA or VA. Significantly young age and wide QRS complex were observed in the SCA/VA group compared to the no-SCA/VA group. The patients in the SCA/VA group had significantly lower RVSP, more presence of LGE, greater LGE volume, and higher LGE proportion than those in the no-SCA/VA group. A high risk for SCA or VA was observed in patients with LGE (odds ratio, 45.525; 95% confidence interval, 2.558–810.140; P = .009).Conclusions: Presence of LGE on CMR is a risk factor for SCA or VA in MVP patients. High LGE volume and LGE proportion may provide additional information for prediction of SCA or VA.

A case report of arrhythmogenic mitral valve disease: still a long way to go

“…In the presence of high-risk features on first-line workup, it is advised to use CMR to further stratify arrhythmic risk prediction. Systolic curling seems to be associated with SCD when evaluated by CMR 9 and could also be appreciated on echocardiogram in our case ( Figure 2 ). Finally, LGE may be present in patients with MVP, usually affecting only one segment, most often LV basal inferolateral, and with a non-ischaemic pattern (most frequently intramural or patchy).…”

Electrical cardioversion of atrial arrhythmias with cardiac amyloidosis in the era of direct oral anticogulants

“…Recently, in the case of thrombus persistence, some authors have postulated the safety and feasibility of LAA closure. 25,26 This could facilitate EC, but at present, the place of this strategy in LAA thrombus management remains unclear. The reasons explaining the variable effects of antithrombotic therapy on LAA thrombus resolution are not fully understood; however, possible important factors may be chronic inflammation, age, structure, and architecture of the clot or associated comorbidities.We identified a significant independent association between creatinine level and antiplatelet agents use with LAT.…”