Left ventricular hypertrophy and ventricular ectopy in mitral valve prolapse

Abstract

Abstract Background Mitral valve prolapse (MVP) is associated with left ventricular hypertrophy (LVH). Individuals with sudden death ascribed to MVP have increased ventricular mass on autopsy. Whether LVH is a risk factor for ventricular arrhythmia in MVP is unknown. Purpose We aimed to describe factors associated with LVH in MVP and the association of LVH with ventricular ectopy in MVP. Methods We studied all 637 patients aged 18 - 90 years with MVP on echocardiography between 2016-19 at our institution (median age [interquartile range] 64.3 [52.3-73.6] years; 52.6% female; 16.2% African American). Echocardiograms were reviewed for LVH, ventricular size and function, and valvular pathology. Complex or frequent ventricular ectopy (cfVE) was defined as >1% burden of premature ventricular complexes or non-sustained ventricular tachycardia on ambulatory electrocardiogram or ≥2 premature ventricular complexes on a 10-second electrocardiogram. Multivariate logistic regression was used to assess relationships between MVP, LVH, and known associations of cfVE in MVP. Resul­ts: LVH was present in 144 (22.6%) patients. A history of hypertension (HTN) was present in 78/144 (54.2%) with LVH vs. 204/493 (41.5%) of those without LVH (p=0.008). On multivariate analysis, LVH was independently associated with moderate to severe mitral regurgitation (odds ratio [95% confidence interval] 3.6 [2.4-5.6]) and heart failure (3.2 [2.0-5.1]), but not HTN (1.3 [0.9-2.0], p=0.205). cfVE was present in 55/144 (38.2%) with LVH vs. 127/493 (25.8%) without LVH (p=0.005). Among those without HTN, cfVE was present in 26/66 (39.4%) of those with LVH vs. 68/288 (23.6%) without LVH (p=0.013). On multivariate analysis, independent predictors of cfVE were age (odds ratio [95% confidence interval] 2.9 [1.1-8.1], p=0.035), mitral annular disjunction (3.2 [1.9-5.3], p<0.0001), heart failure (2.4 [1.4-4.0], p=0.001), bileaflet MVP (2.2 [1.4-3.3], p<0.001), and electrocardiogram inferior lead T-wave inversion (2.2 [1.4-3.4], p<0.001), but not LVH (1.2 [0.7-1.9], p=0.486) whether in presence of HTN (1.0 [0.5-1.9], p=0.959) or absence of HTN (1.4 [0.7-2.8], p=0.344). Conclusion LVH is a common finding in MVP and is associated with mitral regurgitation and heart failure. LVH in MVP is not associated with increased ventricular ectopy. Ventricular ectopy in MVP is related to mitral morphological factors and heart failure.Multivariate predictors of cfVECharacteristics with and without LVH