Table 1.
Studies describing imaging risk factors in patients with MVP.
| Studies | Study design | Total patients | Imaging modality | Arrhythmias | Imaging findings |
|---|---|---|---|---|---|
| Myocardial fibrosis | |||||
| Han et al. (27) | Retrospective | 16 | CMR | 8 patients (NSVT or couplets) | 10 had PM fibrosis. All 8 with VA had fibrosis |
| Basso et al. (1) | Prospective | 44 | CMR | 30 patients (VF = 2, VT = 1, NSVT = 27) | 30 patients with LGE at least one region (25 PM, 16 inferolateral mid-wall, 24 inferolateral basal wall). 28 out 30 with VA had fibrosis |
| Bui et al. (33) | Retrospective | 41 | CMR | 14 patients had NSVT (out of 32 with Holter data) | 11 patients had PM fibrosis; 5 out of 14 patients with VA had PM fibrosis |
| Kitkungvan et al. (2) | Prospective | 177 | CMR | 8 patients had inducible VT, sustained VT, or sudden cardiac death over 3.7 years follow-up. | 65 patients had myocardial fibrosis. The most common locations were basal or mid inferolateral wall and basal inferior wall. Arrhythmic event rate of 7.7% in MVP patients with replacement fibrosis vs. 2.7% in MVP patients without replacement fibrosis |
| Mitral annular disjunction (MAD) | |||||
| Eriksson et al. (43) | Not specified | 32 | TEE | No VA data | 31 of 32 patients had MAD with mean MAD of 10 ± 3 mm |
| Carmo et al. (47) | Retrospective | 38 | TTE | NSVT by Holter (number not specified) | 21 patients had MAD. Average MAD was 7.4 ± 8.7 mm. Patients with NSVT had larger mean MAD. MAD ≥8.5 mm was associated with NSVT |
| Lee et al. (45) | Prospective | 101 | TEE | No VA data | 42 patients had MAD with a median MAD of 8.9 mm |
| Dejgaard et al. (46) | Cross-sectional | 116 patients with MAD, of which 90 had MVP | 115 had TTE and 83 patients had CMR | 26 had NSVT and 14 had sustained VT or SCD | 64 patients with MVP had MAD |
| Essayagh et al. (44) | Prospective | 89 | CMR | NSVT, number not specified | 31 patients had MAD with a mean MAD of 8 ± 4 mm. Patients with MAD had more often NSVT |
| Mechanical dispersion | |||||
| Ermakov et al. (54) | Retrospective | 59 | TTE | 32 patients had complex VA; among these, 9 had secondary prevention ICD | Patients with MVP and VA had higher mechanical dispersion in comparison to those with MVP and no VA (mean 59 ± 21 vs. 43 ± 12, P < 0.001) |
| Pickelhaube sign | |||||
| Muthukumar et al. (58) | Retrospective | 21 | TTE | 10 patients had either VT or VF | 12 (57%) patients had Pickelhaube sign with late high-velocity systolic spike (≥16 cm/s) with higher incidence of malignant VA (67 vs. 22%) |
CMR, cardiovascular magnetic resonance imaging; VT, ventricular tachycardia; NSVT, non-sustained ventricular tachycardia; VF, ventricular fibrillation; PM, papillary muscle; LGE, late gadolinium enhancement; VA, ventricular arrhythmia; TTE, transthoracic echocardiography, TEE, transesophageal echocardiography; MVP, mitral valve prolapse.