La Vecchia L, Ometto R, Centofante P, Varotto L, Bonanno C, Bozzola L, Bevilacqua P, Vincenzi M
Divisione di Cardiologia, Ospedale S. Bortolo, Vicenza, Italy.
Clin Cardiol. 1998 Oct;21(10):731-5. doi: 10.1002/clc.4960211007.
In patients with ventricular tachycardia (VT) and apparently normal hearts, mitral valve prolapse (MVP) is discovered fairly often, raising the question of whether or not it is an occasional finding.
This issue was analyzed in a series of patients with VT and apparently normal hearts in order to define the prevalence of MVP in this condition, the existence of specific diagnostic features suggesting a nonrandom association between idiopathic VT and MVP, and the prognostic implications of this finding.
We studied 28 consecutive patients with documented VT and no history of heart disease. Two-dimensional (2-D) echocardiogram, cardiac catheterization, morphometric examination of endomyocardial biopsy and arrhythmologic evaluation (24-h Holter monitoring, electrophysiologic study, and signal-averaged electrocardiogram) were performed. Inclusion criteria for all patients were angiographically normal coronary arteries, normal biventricular function, and absence of histologic evidence of myocarditis. Data obtained in patients found to have MVP at 2-D echo were compared with those of the remaining patients. Long-term follow-up data were also collected.
The prevalence of MVP in our study group was 25% (7 patients). It was not associated with leaflet dysplasia or significant regurgitation. Biventricular function (ventricular volumes and ejection fraction) was comparable in patients with and without MVP. Patients with MVP had a significantly higher prevalence of ventricular late potentials at signal-averaged electrocardiogram (86 vs. 29%, p = 0.027), more interstitial fibrosis at morphometry (8.5 +/- 3.7 vs. 5.4 +/- 2.7% p = 0.028), and VT of right bundle-branch block morphology (100 vs. 48%; p = 0.044). Other arrhythmologic findings were similar in the two groups. After a mean follow-up of > 5 years, no patient in either group died, and none developed heart failure or severe mitral regurgitation.
Mitral valve prolapse is frequently detected in idiopathic VT. The distinguishing features of this association are (1) VT of right bundle-branch block morphology, (2) high prevalence of ventricular late potentials, and (3) increased fibrosis on endomyocardial biopsy. Ventricular function and other arrhythmologic findings are not specific of this association. Prognosis remains substantially benign, as is true for most cases of idiopathic VT.
在室性心动过速（VT）且心脏外观正常的患者中，二尖瓣脱垂（MVP）相当常见，这就引发了它是否只是偶然发现的问题。
对一系列室性心动过速且心脏外观正常的患者进行了该问题分析，以确定MVP在这种情况下的患病率、是否存在提示特发性室性心动过速与MVP之间存在非随机关联的特定诊断特征，以及这一发现的预后意义。
我们研究了28例有记录的室性心动过速且无心脏病史的连续患者。进行了二维（2-D）超声心动图、心导管检查、心内膜心肌活检的形态学检查以及心律失常评估（24小时动态心电图监测、电生理研究和信号平均心电图）。所有患者的纳入标准为冠状动脉造影正常、双心室功能正常以及无心肌炎的组织学证据。将二维超声心动图发现有MVP的患者所获得的数据与其余患者的数据进行比较。还收集了长期随访数据。
我们研究组中MVP的患病率为25%（7例患者）。它与瓣叶发育异常或明显反流无关。有和没有MVP的患者双心室功能（心室容积和射血分数）相当。有MVP的患者在信号平均心电图上心室晚电位的患病率显著更高（86%对29%，p = 0.027），形态学检查显示间质纤维化更多（8.5±3.7%对5.4±2.7%，p = 0.028），且右束支传导阻滞形态的室性心动过速更多（100%对48%；p = 0.044）。两组的其他心律失常发现相似。平均随访>5年后，两组均无患者死亡，也无患者发生心力衰竭或严重二尖瓣反流。
特发性室性心动过速患者中经常检测到二尖瓣脱垂。这种关联的显著特征是：（1）右束支传导阻滞形态的室性心动过速，（2）心室晚电位的高患病率，以及（3）心内膜心肌活检显示纤维化增加。心室功能和其他心律失常发现并非这种关联所特有。预后仍然基本良好，特发性室性心动过速的大多数病例情况也是如此。
