Calicchio Francesca, Lim Lisa J, Cross Danielle, Bibby Dwight, Fang Qizhi, Meisel Karl, Schiller Nelson B, Delling Francesca N
Department of Medicine (Cardiovascular Division), The Lundquist Institute at Harbor-University of California-Los Angeles Medical Center, Torrance, CA, United States.
Department of Medicine (Cardiovascular Division), University of California-San Francisco, San Francisco, CA, United States.
Front Neurol. 2023 Jul 25;14:1058697. doi: 10.3389/fneur.2023.1058697. eCollection 2023.
Mitral valve prolapse (MVP) has been associated with an increased risk of ischemic stroke. Older age, thicker mitral leaflets, and significant mitral regurgitation (MR) leading to atrial fibrillation have been traditionally considered risk factors for ischemic stroke in MVP. However, specific risk factors for MVP-stroke subtypes are not well defined. The aim of this study is to evaluate clinical and echocardiographic parameters, including left atrial (LA) function, in MVP with cryptogenic (C) vs. non-cryptogenic (NC) stroke.
In this case-control matched study, MVPs were identified in consecutive echocardiograms obtained after a stroke from January 2013 to December2016 at the University of California, San Francisco. MVP was defined as leaflet displacement ≥2 mm in the parasternal long-axis view at end-systole. Age/gender matched MVPs without stroke and healthy controls without MVP were also identified. We analyzed LA end-systolic/diastolic volume index, emptying fraction (LAEF), function index (LAFI), and global longitudinal strain in all MVPs and controls. We also measured left ventricular (LV) volume indexes, mass index, ejection fraction (EF), degree of MR and leaflet thickness.
We identified a total of 30 MVPs (age 70 ± 12, 50% females) with stroke (11 with C- and 19 with NC-stroke), 20 age/gender matched MVPs without a stroke and 16 controls. MVPs without stroke had lower BMI, less hypertension but more MR (≥moderate in 45% vs. 17%), more abnormal LA function (lower LAEF, LAFI) and larger LV volumes/mass (all < 0.05) when compared to MVPs with stroke. Leaflet thickness was overall mild (<3 mm) and similar in the 2 groups. Within the MVP stroke group, NC-stroke had higher BMI, more hypertension and more atrial fibrillation compared to C-stroke. In the variables tested, patients with C-stroke did not differ from controls.
MVP-related MR may be protective against stroke despite abnormal LA function. Risk of NC-stroke in MVP is related to common stroke risk factors rather than mitral valve leaflet thickness. The etiology of C-stroke in MVP warrants further studies.
二尖瓣脱垂（MVP）与缺血性卒中风险增加相关。年龄较大、二尖瓣叶较厚以及导致房颤的显著二尖瓣反流（MR）传统上被认为是MVP患者发生缺血性卒中的危险因素。然而，MVP相关卒中亚型的特定危险因素尚不明确。本研究旨在评估MVP合并隐源性（C）与非隐源性（NC）卒中患者的临床和超声心动图参数，包括左心房（LA）功能。
在这项病例对照匹配研究中，于2013年1月至2016年12月在加利福尼亚大学旧金山分校对卒中后连续超声心动图检查中发现的MVP患者进行了评估。MVP定义为收缩末期胸骨旁长轴视图中叶瓣移位≥2mm。同时还确定了年龄/性别匹配的无卒中MVP患者和无MVP的健康对照。我们分析了所有MVP患者和对照的LA收缩末期/舒张末期容积指数、排空分数（LAEF）、功能指数（LAFI）和整体纵向应变。我们还测量了左心室（LV）容积指数、质量指数、射血分数（EF）、MR程度和瓣叶厚度。
我们共确定了30例发生卒中的MVP患者（年龄70±12岁，50%为女性）（11例为C型卒中，19例为NC型卒中），20例年龄/性别匹配的无卒中MVP患者和16例对照。与发生卒中的MVP患者相比，无卒中的MVP患者BMI较低，高血压较少，但MR较多（≥中度者分别为45%和17%），LA功能异常更多（LAEF、LAFI较低），LV容积/质量更大（均P<0.05）。瓣叶厚度总体较轻（<3mm），两组相似。在MVP卒中组中，与C型卒中相比，NC型卒中患者BMI更高，高血压更多，房颤更多。在检测的变量中，C型卒中患者与对照无差异。
尽管LA功能异常，但MVP相关的MR可能对卒中具有保护作用。MVP患者发生NC型卒中的风险与常见的卒中危险因素有关，而非二尖瓣叶厚度。MVP患者C型卒中的病因值得进一步研究。
