Compagnucci Paolo, Selimi Adelina, Cipolletta Laura, Volpato Giovanni, Gasperetti Alessio, Valeri Yari, Parisi Quintino, Curcio Antonio, Natale Andrea, Dello Russo Antonio, Casella Michela
Cardiology and Arrhythmology Clinic, Marche University Hospital, 60126 Ancona, Italy.
Department of Biomedical Sciences and Public Health, Marche Polytechnic University, 60121 Ancona, Italy.
J Clin Med. 2024 Feb 27;13(5):1350. doi: 10.3390/jcm13051350.
Although mitral valve prolapse (MVP) is the most prevalent valvular abnormality in Western countries and generally carries a good prognosis, a small subset of patients is exposed to a significant risk of malignant ventricular arrhythmias (VAs) and sudden cardiac death (SCD), the so-called arrhythmic MVP (AMVP) syndrome. Recent work has emphasized phenotypical risk features of severe AMVP and clarified its pathophysiology. However, the appropriate assessment and risk stratification of patients with suspected AMVP remains a clinical conundrum, with the possibility of both overestimating and underestimating the risk of malignant VAs, with the inappropriate use of advanced imaging and invasive electrophysiology study on one hand, and the catastrophic occurrence of SCD on the other. Furthermore, the sports eligibility assessment of athletes with AMVP remains ill defined, especially in the grey zone of intermediate arrhythmic risk. The definition, epidemiology, pathophysiology, risk stratification, and treatment of AMVP are covered in the present review. Considering recent guidelines and expert consensus statements, we propose a comprehensive pathway to facilitate appropriate counseling concerning the practice of competitive/leisure-time sports, envisioning shared decision making and the multidisciplinary "sports heart team" evaluation of borderline cases. Our final aim is to encourage an active lifestyle without compromising patients' safety.
虽然二尖瓣脱垂（MVP）是西方国家最常见的瓣膜异常，且总体预后良好，但一小部分患者面临着发生恶性室性心律失常（VAs）和心源性猝死（SCD）的重大风险，即所谓的心律失常性MVP（AMVP）综合征。最近的研究强调了严重AMVP的表型风险特征，并阐明了其病理生理学。然而，对疑似AMVP患者进行适当的评估和风险分层仍然是一个临床难题，一方面可能高估或低估恶性VAs的风险，不恰当地使用先进的影像学检查和有创电生理检查，另一方面则可能发生SCD这种灾难性事件。此外，对患有AMVP的运动员进行运动资格评估仍不明确，尤其是在心律失常风险处于中间灰色地带的情况下。本综述涵盖了AMVP的定义、流行病学、病理生理学、风险分层和治疗。考虑到最近的指南和专家共识声明，我们提出了一条全面的途径，以促进就竞技/休闲运动实践进行适当的咨询，设想共同决策以及对临界病例进行多学科“运动心脏团队”评估。我们的最终目标是鼓励积极的生活方式，同时不损害患者的安全。
