Abstract 16105: Sex-Based Differences in Potential Risk Factors for Sudden Death in Patients With Mitral Valve Prolapse

Abstract

Background: The majority of individuals experiencing sudden arrhythmic death attributable to mitral valve prolapse (MVP) are women. However, factors leading to this increased risk in women are unknown. Aims: To describe sex differences in factors associated with MVP. Methods: We studied 637 patients aged 18-90 with MVP diagnosed by echocardiography at our center between 2016 and 2019. Clinical, echocardiographic and ECG parameters were compared between men and women using Fisher’s exact and Wilcoxon rank-sum tests, including features associated with arrhythmic MVP (bileaflet prolapse, mitral annular disjunction [MAD], ECG T-wave inversion (TWI), and complex or frequent ventricular ectopy (cfVE) including nonsustained ventricular tachycardia [NSVT]). All statistical tests are univariate, reported as OR [95% CI], and p-values are two-sided. Results: Among patients with MVP, 335 (52.6%) were women, 103 (16.2%) were African American and median (IQR) age was 67 (55-76.5) years. Women were more likely than men to have MAD (60/335 [17.9%] vs 35/302 [11.6%] respectively, 1.66 [1.06-2.61], p=0.026) and less likely to have moderate or severe mitral regurgitation (85/335 [25.4%] vs 99/302 [32.8%] respectively, 0.70 [0.49-0.98], p=0.044). There was no difference between women and men in presence of other features associated with arrhythmic MVP. Men were more likely than women to have cardiometabolic risk factors for sudden death including hypertension, diabetes, dyslipidemia, coronary artery disease, and heart failure. Conclusions: In patients with mitral valve prolapse, potential risk factors for sudden death vary by sex. Women are more likely than men to have mitral annular disjunction, while men are more likely to have cardiometabolic risk factors. Further studies are needed to determine whether mitral annular disjunction-associated ventricular arrhythmias can explain the increased incidence of sudden arrhythmic death in women with mitral valve prolapse.