High-risk phenotypes of arrhythmic mitral valve prolapse: a systematic review and meta-analysis

Abstract

Background Mitral valve prolapse (MVP) is associated with aggravated risk of ventricular tachycardia (VT), ventricular fibrillation (VF) and sudden cardiac death (SCD). There is a lack of specific guideline recommendation regarding risk stratification and management, despite multiple proposed high-risk phenotypes. We performed systematic review and meta-analysis to evaluate high-risk phenotypes for malignant arrhythmias in patients with MVP. Methods We comprehensively searched the databases of MEDLINE, SCOPUS, and EMBASE from inception to April 2023. Included studies were cohort and case-control comparing between MVP patients with and without VT, VF, cardiac arrest, ICD placement, or SCD. Data from each study were combined using the random-effects. Pooled odds ratios (OR) and 95% confidence intervals (CI) were calculated. Results Nine studies from 1985 to 2023 were included involving 2,279 patients with MVP. We found that T-wave inversion (OR 2.52; 95% CI: 1.90–3.33; p < 0.001), bileaflet involvement (OR 2.28; 95% CI: 1.69–3.09; p < 0.001), late gadolinium enhancement (OR 17.05; 95% CI: 3.41–85.22; p < 0.001), mitral annular disjunction (OR 3.71; 95% CI: 1.63–8.41; p < 0.002), and history of syncope (OR 6.96; 95% CI: 1.05–46.01; p = 0.044), but not female (OR 0.96; 95% CI: 0.46–2.01; p = 0.911), redundant leaflets (OR 4.30; 95% CI: 0.81–22.84; p = 0.087), or moderate-to-severe mitral regurgitation (OR 1.24; 95% CI: 0.65–2.37; p = 0.505), were associated with those events. Conclusion Bileaflet prolapse, T-wave inversion, mitral annular disjunction, late gadolinium enhancement, and history of syncope are high-risk phenotypes among population with MVP. Further research is needed to validate the risk stratification model and justify the role of primary prophylaxis against malignant arrhythmias.