Name:
Mitral Valve Prolapse and Sudden Cariac Death
Description:
Mitral Valve Prolapse and Sudden Cariac Death
Thumbnail URL:
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Duration:
T00H04M26S
Embed URL:
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Content URL:
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Upload Date:
2022-02-28T00:00:00.0000000
Transcript:
Language: EN.
Segment:0 .
>> Practice Impact Extra podcasts are derived from Hurst's the Heart Board Review and other online resources available only through accesscardiology.com. >> Indeed, the immediate thought upon hearing the diagnosis of mitral valve prolapse is usually not that it's associated with sudden cardiac death. What do we know of this association? Hi, Dr. Bernie here, and welcome to Practice Impact Extra.
The prevalence of mitral valve prolapse diagnosed on echocardiogram is approximately 2% to 3% in the general population. Mitral valve prolapse is commonly observed as a benign finding. However, the literature suggests that it may be associated with sudden cardiac death. A systemic review and meta-analysis of mitral valve prolapse and sudden cardiac death literature published in 2018 in the British Medical Journal, as well as an article published in 2019 in the Journal of the American Heart Association, they researched mitral valve prolapse in the community and what was its prevalence, what was the incidence of sudden cardiac death in mitral valve prolapse, what was the prevalence of mitral valve prolapse in sudden cardiac death, and what were the pre-mortem risk factors for sudden cardiac death?
The instance of sudden cardiac death in the mitral valve population is estimated at 0.14% -- that's 0.14 -- to 0.4%, yet there was a study published in circulation from Italy in September 2019 that noticed mitral valve prolapse and sudden cardiac death was noted in 7% of all sudden cardiac deaths in that trial in Italy. The absolute number of people who are exposed to the risk of sudden cardiac death is significant, although the incidence, the incidence of life-threatening arrhythmic events in the general mitral valve prolapse population really remains low.
What are the prospective identifications of patients with mitral valve prolapse who may be at risk for sudden cardiac death? I think this is challenging. Over time, observational data has accumulated regarding patients with mitral valve prolapse who survived fatal arrhythmias, and they looked and found a malignant phenotype for these high-risk characteristics for certain cardiac death. So, what were these high-risk characteristics? Well, they included female gender, bileaflet prolapse, repolarization abnormalities on electrocardiogram, particularly in the inferior leads, complex ventricular arrhythmias with polymorphic right bundle branch block pattern morphology, PVCs arising from the [inaudible] tissues and papillary muscle, focal left capillary muscle fibrosis or inferior basal scarring, electrocardiogram -- excuse me -- and echocardiogram demonstrating a spiked high-velocity signal across the lateral mitral annulus, and finally, contrast-enhanced MRI demonstrating myocardial scarring.
So, what's my take? I think the literature has provided evidence that there is a real association between mitral valve prolapse and sudden cardiac death. The clinical challenge is to identify patients with this arrhythmic mitral valve prolapse and how to treat them to prevent sudden cardiac death. I believe there is significant benefit in assessing mitral valve prolapse patients and using the above criteria to risk stratify. Thank you again for joining me, and see you next time on Practice Impact Extra.
>> We hope you enjoyed this podcast from McGraw-Hill. Subscribers to AccessCardiology have instant access to over 25,000 pages of rich medical content, receive medical updates from trusted experts, and have access to other special features. To subscribe or learn more, please visit accesscardiology.com.
