Kumar Narayanan1, Audrey Uy-Evanado1, Carmen Teodorescu1, Kyndaron Reinier1, Gregory A Nichols2, Karen Gunson3, Jonathan Jui4, Sumeet S Chugh5. 1. The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California. 2. Center for Health Research, Kaiser Permanente, Portland, Oregon. 3. Department of Pathology, Oregon Health and Science University, Portland, Oregon. 4. Department of Emergency Medicine, Oregon Health and Science University, Portland, Oregon. 5. The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California. Electronic address: sumeet.chugh@cshs.org.
Abstract
BACKGROUND: Mitral valve prolapse (MVP) is relatively common in the general population with recently reported prevalence of 1% and familial clustering (Framingham Heart Study). However, its association with ventricular arrhythmias and sudden cardiac arrest (SCA) remains controversial. OBJECTIVES: The purpose of this study was to characterize the frequency and clinical profile of patients with MVP who suffer SCA in the community. METHODS: Patients with SCA cases were prospectively identified in the population-based Oregon Sudden Unexpected Death Study (population ~1 million). The presence of MVP was identified from echocardiograms recorded prior but unrelated to the SCA event. The detailed clinical profile of patients with SCA and MVP was compared with that of SCA patients without MVP to identify potential differences. RESULTS: A total of 729 SCA patients were evaluated over a 12-year period (mean age 69.5 ± 14.8 years; 64.6% men). MVP was observed in 17 (2.3%) prior to the SCA event (95% confidence interval 1.2%-3.4%). Mitral regurgitation was present in 14 SCA patients with MVP (82.3%) and was moderate or severe in 10 (58.8%). Compared with SCA patients without MVP, SCA patients with MVP were younger (mean age 60.9 ± 16.4 years vs 69.7 ± 14.7 years; P = .02), with fewer risk factors (diabetes 5.9% vs 46.4%; P = .001; hypertension 41.2% vs 78.9%; P = .001) or known coronary disease (29.4% vs 65.6%; P < .001). CONCLUSION: MVP was observed in a small proportion (2.3%) of SCA patients in the general population, suggesting a low risk overall. Since SCA patients with MVP were characterized by younger age and relatively low cardiovascular comorbidity, a focus on imaging for valve structure/insufficiency as well as genetics could aid future risk stratification approaches.
BACKGROUND:Mitral valve prolapse (MVP) is relatively common in the general population with recently reported prevalence of 1% and familial clustering (Framingham Heart Study). However, its association with ventricular arrhythmias and sudden cardiac arrest (SCA) remains controversial. OBJECTIVES: The purpose of this study was to characterize the frequency and clinical profile of patients with MVP who suffer SCA in the community. METHODS:Patients with SCA cases were prospectively identified in the population-based Oregon Sudden Unexpected Death Study (population ~1 million). The presence of MVP was identified from echocardiograms recorded prior but unrelated to the SCA event. The detailed clinical profile of patients with SCA and MVP was compared with that of SCApatients without MVP to identify potential differences. RESULTS: A total of 729 SCApatients were evaluated over a 12-year period (mean age 69.5 ± 14.8 years; 64.6% men). MVP was observed in 17 (2.3%) prior to the SCA event (95% confidence interval 1.2%-3.4%). Mitral regurgitation was present in 14 SCApatients with MVP (82.3%) and was moderate or severe in 10 (58.8%). Compared with SCApatients without MVP, SCApatients with MVP were younger (mean age 60.9 ± 16.4 years vs 69.7 ± 14.7 years; P = .02), with fewer risk factors (diabetes 5.9% vs 46.4%; P = .001; hypertension 41.2% vs 78.9%; P = .001) or known coronary disease (29.4% vs 65.6%; P < .001). CONCLUSION: MVP was observed in a small proportion (2.3%) of SCApatients in the general population, suggesting a low risk overall. Since SCApatients with MVP were characterized by younger age and relatively low cardiovascular comorbidity, a focus on imaging for valve structure/insufficiency as well as genetics could aid future risk stratification approaches.
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