Bazoukis George, Saplaouras Athanasios, Vlachos Konstantinos, Mililis Panagiotis, Letsas Konstantinos P, Efremidis Michael, Liu Tong, Tse Gary
From the Department of Cardiology, Larnaca General Hospital, Larnaca, Cyprus.
Department of Basic and Clinical Sciences, University of Nicosia Medical School, Nicosia, Cyprus.
Cardiol Rev. 2023 Jun 19. doi: 10.1097/CRD.0000000000000577.
Mitral valve prolapse (MVP) has an estimated prevalence of 2-3% in the general population. Patients with MVP have an increased risk of ventricular arrhythmic events. The aim of this meta-analysis was to identify easily obtained markers that can be used for the arrhythmic risk stratification of MVP patients. This meta-analysis was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA Statement). The search strategy identified 23 studies that were finally included in the study. The quantitative synthesis showed that late gadolinium enhancement (LGE) [RR 6.40 (2.11-19.39), I2 77%, P = 0.001], longer QTc interval [mean difference: 14.2 (8.92-19.49) I2 0%, P < 0.001], T-wave inversion in inferior leads [RR 1.60 (1.39-1.86), I2 0%, P < 0.001], mitral annular disjunction (MAD) [RR 1.77 (1.29-2.44), I2 37%, P = 0.0005], lower left ventricular ejection fraction (LVEF) [mean difference: -0.77 (-1.48, -0.07) I2 0%, P = 0.03], bileaflet MVP [RR 1.32 (1.16-1.49), I2 0%, P < 0.001], increased anterior [mean difference: 0.45 (0.28, 0.61), I2 0%, P < 0.001] and posterior [mean difference: 0.39 (0.26, 0.52), I2 0%, P < 0.001] mitral leaflet thickness were significantly associated with ventricular arrhythmias in MVP patients. On the other hand, gender, QRS duration, anterior, and posterior mitral leaflet length were not associated with increased risk of arrhythmias. In conclusion, inferior T-wave inversions, QTc interval, LGE, LVEF, MAD, bileaflet MVP, anterior, and posterior mitral leaflet thickness are easily obtained markers that can be used for the risk stratification of patients with MVP. Prospective studies should be designed for the better stratification of this population.
二尖瓣脱垂（MVP）在普通人群中的估计患病率为2%-3%。MVP患者发生室性心律失常事件的风险增加。本荟萃分析的目的是确定可用于MVP患者心律失常风险分层的易于获取的标志物。本荟萃分析是按照系统评价和荟萃分析的首选报告项目（PRISMA声明）进行的。检索策略确定了最终纳入研究的23项研究。定量综合分析表明，钆延迟增强（LGE）[相对危险度（RR）6.40（2.11-19.39），I² 77%，P = 0.001]、较长的QTc间期[平均差值：14.2（8.92-19.49），I² 0%，P < 0.001]、下壁导联T波倒置[RR 1.60（1.39-1.86），I² 0%，P < 0.001]、二尖瓣环分离（MAD）[RR 1.77（1.29-2.44），I² 37%，P = 0.0005]、较低的左心室射血分数（LVEF）[平均差值：-0.77（-1.48，-0.07），I² 0%，P = 0.03]、双叶MVP[RR 1.32（1.16-1.49），I² 0%，P < 0.001]、二尖瓣前叶[平均差值：0.45（0.28，0.61），I² 0%，P < 0.001]和后叶[平均差值：0.39（0.26，0.52），I² 0%，P < 0.001]厚度增加与MVP患者的室性心律失常显著相关。另一方面，性别、QRS时限、二尖瓣前叶和后叶长度与心律失常风险增加无关。总之，下壁T波倒置、QTc间期、LGE、LVEF、MAD、双叶MVP、二尖瓣前叶和后叶厚度是可用于MVP患者风险分层的易于获取的标志物。应设计前瞻性研究以更好地对该人群进行分层。
