University of North Carolina School of Medicine, Chapel Hill, North Carolina.
Department of Medicine, Southeast Health Medical Center, Dothan, Alabama.
Heart Rhythm. 2024 Oct;21(10):1803-1810. doi: 10.1016/j.hrthm.2024.05.049. Epub 2024 May 31.
Mitral annular disjunction (MAD) is associated with ventricular arrhythmia in mitral valve prolapse (MVP). The proportional risk from MAD and other predictors of ventricular arrhythmia in MVP has not been well characterized.
This study aimed to identify predictors of complex or frequent ventricular ectopy (cfVE) in MVP and to quantify risk of cfVE and mortality in MVP with MAD.
We studied 632 adult patients with MVP on transthoracic echocardiography at the University of North Carolina Medical Center from 2016 to 2019 (median age, 64 [interquartile range, 52-74] years; 52.7% female; 16.3% African American). Resting and ambulatory electrocardiograms were used to identify cfVE.
MAD was present in 94 (14.9%) patients. Independent associations of MAD were bileaflet prolapse (odds ratio [95% CI], 4.25 [2.47-7.33]; P < .0001), myxomatous valve (2.17 [1.27-3.71]; P = .005), absence of hypertension (2.00 [1.21-3.32]; P = .007), electrocardiogram inferior or lateral lead T-wave inversion (2.07 [1.23-3.48]; P = .006), and female sex (1.99 [1.21-3.25]; P = .006). cfVE was frequent with MAD (39 [41.5%] vs 93 [17.3%] without; P < .0001). Independent cfVE predictors were MAD (hazard ratio [95% CI], 2.23 [1.47-3.36]; P = .0001), bileaflet prolapse (1.86 [1.25-2.76]; P = .002), heart failure (1.79 [1.16-2.77]; P = .009), lower left ventricular ejection fraction (0.14 [0.03-0.61]; P = .009), coronary artery disease (1.60 [1.05-2.43]; P = .03), and inferior or lateral lead T-wave inversion (1.51 [1.03-2.22]; P = .03). After a median of 40 (33-48) months, there was increased mortality with MAD (P = .04).
MAD in MVP is associated with bileaflet or myxomatous MVP, absence of hypertension, T-wave inversion, and female sex. There is increased cfVE and mortality with MAD, highlighting the need for closer follow-up of these patients.
二尖瓣环分离（MAD）与二尖瓣脱垂（MVP）中的室性心律失常有关。MAD 与其他 MVP 中心律失常预测因子的比例风险尚未得到很好的描述。
本研究旨在确定 MVP 中复杂或频繁室性异位（cfVE）的预测因子，并定量评估 MAD 与 MVP 中心律失常和死亡率的风险。
我们研究了 2016 年至 2019 年期间在北卡罗来纳大学医学中心接受经胸超声心动图检查的 632 例成人 MVP 患者（中位年龄 64 [四分位距 52-74] 岁；52.7%为女性；16.3%为非裔美国人）。静息和动态心电图用于识别 cfVE。
94 例（14.9%）患者存在 MAD。MAD 的独立关联因素包括双瓣叶脱垂（优势比[95%置信区间]，4.25 [2.47-7.33]；P <.0001）、黏液瘤样瓣膜（2.17 [1.27-3.71]；P =.005）、无高血压（2.00 [1.21-3.32]；P =.007）、心电图下壁或外侧导联 T 波倒置（2.07 [1.23-3.48]；P =.006）和女性（1.99 [1.21-3.25]；P =.006）。MAD 患者 cfVE 较频繁（39 [41.5%] vs 93 [17.3%]；P <.0001）。cfVE 的独立预测因子包括 MAD（风险比[95%置信区间]，2.23 [1.47-3.36]；P =.0001）、双瓣叶脱垂（1.86 [1.25-2.76]；P =.002）、心力衰竭（1.79 [1.16-2.77]；P =.009）、左心室射血分数较低（0.14 [0.03-0.61]；P =.009）、冠状动脉疾病（1.60 [1.05-2.43]；P =.03）和下壁或外侧导联 T 波倒置（1.51 [1.03-2.22]；P =.03）。在中位数为 40（33-48）个月的随访中，MAD 患者死亡率升高（P =.04）。
MVP 中的 MAD 与双瓣叶或黏液瘤样 MVP、无高血压、T 波倒置和女性有关。MAD 与 MVP 中心律失常和死亡率增加有关，这突出表明需要对这些患者进行更密切的随访。
