Abstract 13720: Mitral Valve Prolapse And Sudden Death: A Systematic Review
Introduction: Mitral valve prolapse (MVP) is commonly observed as a benign finding in the general population. There is a suggestion from the literature that MVP is associated with unexplained sudden cardiac death (SCD) in patients with otherwise “structurally normal hearts”.
Aim: We performed a systematic review 1) to determine the prevalence of MVP in unexplained SCD cohorts, 2) to determine the presence of MVP in the general population and 3) to evaluate the incidence of SCD in patients with MVP.
Methods: An electronic search of the English medical literature (Pubmed, Medline, Cochrane and EMBase) was conducted on 1st July 2014. 667 references were imported into Endnote and reviewed. Reference lists of relevant studies and review articles were screened to retrieve non-indexed articles. All patients with known precipitants for death or cardiac arrest were excluded. 20 studies were identified with 13 examining MVP in unexplained SCD and 7 examining SCD in patients with MVP. A random effects model was utilized and meta-analysis was performed using STATA version 13.0.
Results: The cause for SCD was not identified in 28.3% of autopsy studies. The prevalence of MVP in cohorts with unexplained SCD was 13.3% (95% CI 6.8, 21.3). The community prevalence of MVP was 1.6% (95% CI 1, 2.8) and the incidence of unexplained SCD in the MVP population was 0.2% (0.1, 0.3) per year. Based on current census data, we project that MVP presently affects approximately 5.1 million people in the United States and is estimated to climb to 6.3 million by 2050. Accordingly, the number of SCD victims with MVP will climb from 10, 200 to 12, 600. Bileaflet prolapse, moderate to severe mitral regurgitation, ventricular fibrosis and ventricular ectopy were observed more commonly in patients with unexplained SCD and MVP.
Conclusion: The prevalence of MVP in victims of unexplained SCD is high. Although the incidence of life threatening arrhythmic events in the general MVP population remains low, the absolute number of people exposed to the risk of SCD will be large given the high prevalence of MVP. Further work is required to delineate potential risk factors for sudden death in patients with MVP.
Author Disclosures: C.J. Nalliah: None. R. Mahajan: None. H. Haqqani: None. D.H. Lau: None. J. Vohra: None. J.B. Morton: None. J.M. Kalman: Research Grant; Modest; Medtronic, St Jude, Biosense Webster. Other Research Support; Modest; Boston Scientific, Biosense Webster. Consultant/Advisory Board; Modest; Biotronik. P. Sanders: Research Grant; Modest; Medtronic, St Jude Medical, Boston Scientific, Biotronik, Sorin Medical. Other Research Support; Modest; Biosense Webster. Consultant/Advisory Board; Modest; Biosense Webster, Medtronic, St Jude Medical. Other; Modest; Medtonic, St Jude Medical.
- © 2015 by American Heart Association, Inc.