Mitral valve prolapse in relation to sport

2019 ◽  
pp. 226-233
Author(s):  
Christian Schmied ◽  
Sanjay Sharma
Keyword(s):  
Mitral Valve ◽  
Athletic Training ◽  
Mitral Valve Prolapse ◽  
Cerebrovascular Accident ◽  
Cardiac Death ◽  
Comprehensive Evaluation ◽  
Structural Abnormalities ◽  
Definition Of ◽  
And Function ◽  
Myxoid Degeneration

Depending on the definition of the disease and diagnostic criteria mitral valve prolapse (MVP) is one of the commonest structural abnormalities of the heart. The condition is characterized by myxoid degeneration of the mitral valve and appears to be more common in females. Trans-thoracic echocardiography is the primary diagnostic tool for diagnosing MVP and provides information about the structure and function of the valve, but also allows comprehensive evaluation of the subvalvular complex. Additional trans-oesophageal echocardiography and 3D echocardiography provide excellent further assessment of the mitral valve complex. The vast majority of patients have a relatively benign natural history. However, a small proportion may develop severe mitral regurgitation due to degenerative disease or chordal rupture, infective endocarditis, embolic cerebrovascular accident, supraventricular and ventricular arrhythmias, and sudden cardiac death. Athletic training has the potential for expediting the degenerative process and a propensity for arrhythmias or even sudden death.

scholarly journals Arrhythmic Mitral Valve Prolapse: Introducing an Era of Multimodality Imaging-Based Diagnosis and Risk Stratification

Diagnostics ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. 467
Author(s):  
Deni Kukavica ◽  
Marco Guglielmo ◽  
Andrea Baggiano ◽  
Giuseppe Muscogiuri ◽  
Laura Fusini ◽  
...  
Keyword(s):  
Sudden Cardiac Death ◽  
Mitral Valve ◽  
Mitral Valve Prolapse ◽  
Cardiac Death ◽  
Multimodality Imaging ◽  
Female Gender ◽  
Imaging Features ◽  
Comprehensive Overview ◽  
Cardiac Condition ◽  
And Function

Mitral valve prolapse is a common cardiac condition, with an estimated prevalence between 1% and 3%. Most patients have a benign course, but ever since its initial description mitral valve prolapse has been associated to sudden cardiac death. Although the causal relationship between mitral valve prolapse and sudden cardiac death has never been clearly demonstrated, different factors have been implicated in arrhythmogenesis in patients with mitral valve prolapse. In this work, we offer a comprehensive overview of the etiology and the genetic background, epidemiology, pathophysiology, and we focus on the state-of-the-art imaging-based diagnosis of mitral valve prolapse. Going beyond the classical, well-described clinical factors, such as young age, female gender and auscultatory findings, we investigate multimodality imaging features, such as alterations of anatomy and function of the mitral valve and its leaflets, the structural and contractile anomalies of the myocardium, all of which have been associated to sudden cardiac death.

scholarly journals 407 Is Pickelhaube Sign really the hallmark of arrhythmogenic MVP in athletes? And does MVP really cause sudden death? A case report

2020 ◽  
Vol 22 (Supplement_N) ◽  
pp. N131-N131
Author(s):  
Massimo Bolognesi
Keyword(s):  
Mitral Valve ◽  
Sudden Death ◽  
Mitral Valve Prolapse ◽  
Sports Medicine ◽  
Cardiac Death ◽  
Stress Test ◽  
Mitral Annulus ◽  
Unexpected Death ◽  
Premature Ventricular Contractions ◽  
Military Helmet

Abstract The Pickelhaube Sign is today recognized as a novel Echocardiographic Risk Marker for Malignant Mitral Valve Prolapse Syndrome. Mitral Valve Prolapse (MVP) has long been recognized to be a relatively common valve abnormality in the general population. Patients with relatively non-specific symptoms and asymptomatic athletes who have MVP still represent an important clinical conundrum for any physician involved in preventive medicine and sports screening. Although cardiac arrhythmias and/or cardiac death are an undesirable problem in MVP patients, when these subjects were studied with Holter Electrocardiogram (ECG) monitoring a prevalence of ventricular arrhythmias up to 34% was observed, with premature ventricular contractions as the most common pattern (66% of cases). At this regard a paper by Anders et al. described a series of cases that suggest that even clinically considered benign cases of MVP in young adults may cause sudden and unexpected death. However, cardiac arrest and Sudden Arrhythmic Cardiac Death (SCD) resulted in rare events only in patients with MVP based on data from a community study. A middle-aged athletic male who has been practicing competitive cycling for about 20 years came to our Sports Medicine Centre to undergo screening of sports preparation for competitive cycling and the related renewal of certification for participation in sports competitions. This athlete was always considered suitable in previous competitive fitness assessments performed in other sports medicine centers. His family history was unremarkable, as well as his recent and remote pathological anamnesis. The physical examination revealed a 3/6 regurgitation heart murmur with a click in the mid late systole. Previous echocardiographic examinations revealed a MVP which was considered benign with mild not relevant mitral regurgitation. He did not complain of symptoms such as dyspnoea or heart palpitations during physical activity. The resting ECG showed negative T waves in the inferior limb leads, and the stress test showed sporadic premature ventricular beats (a couple) with right bundle branch block morphology. An echocardiogram confirmed the presence of a classic mitral valve prolapse with billowing of both mitral leaflets, associated with a mild to moderate valve regurgitation. The TDI exam at the level of the lateral mitral annulus showed a high-velocity mid-systolic spike like a Pickelhaube sign, i.e. spiked German military helmet morphology. Consequently, an in-depth diagnostic imaging with cardiac magnetic resonance imaging was proposed, but the athlete refused it, both because he was totally asymptomatic and above all because he would be forced to pay a considerable amount of money as the examination is not guaranteed by the Italian National Health Service. In conclusion, the athlete remained sub judice as for competitive suitability, Finally, the question is: does MVP really cause sudden death? Is it enough to detect the Pickelhaube signal by echocardiography to stop this athlete? Let us bear in mind that this athlete was asymptomatic, and he had not had any trouble during exercise and maximal effort for many years. Why must we declare him unsuitable to do competitive sports?

scholarly journals SUDDEN CARDIAC DEATH IN MALIGNANT BILEAFLET MITRAL VALVE PROLAPSE

2015 ◽  
Vol 65 (10) ◽  
pp. A751
Author(s):  
Swapna Kanuri ◽  
Pallavi Bellamkonda ◽  
Aryan Mooss
Keyword(s):  
Sudden Cardiac Death ◽  
Mitral Valve ◽  
Mitral Valve Prolapse ◽  
Cardiac Death

scholarly journals 1045 T1-mapping and CMR feature tracking in mitral valve prolapse

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
M Guglielmo ◽  
L Fusini ◽  
G Muscogiuri ◽  
A Baggiano ◽  
A Loffreno ◽  
...  
Keyword(s):  
Sudden Cardiac Death ◽  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Mitral Valve Prolapse ◽  
Cardiac Death ◽  
Feature Tracking ◽  
T1 Mapping ◽  
Remote Myocardium ◽  
Severe Mitral Regurgitation ◽  
T1 Map

Abstract BACKGROUND Several studies suggest that mitral valve prolapse (MVP) can be related to sudden cardiac death, owing to sustained ventricular arrhythmias (VAs). In patients with sudden cardiac death and complex VAs, a high percentage of either left ventricle (LV) papillary muscle fibrosis or inferobasal fibrosis has been described using cardiac magnetic resonance (CMR) with late gadolinium enhancement technique (LGE). However, LGE presents several technical limitations and requires contrast agent administration. Thanks to T1 mapping (T1-map) and feature tracking (FT) techniques, CMR may identify myocardial fibrosis and deformation abnormalities respectively. We sought to demonstrate that, in patients with MVP, T1 map can accurately identify the presence of myocardial fibrosis which, being related to myocardial stiffness, is associated to abnormal deformation indexes at CMR FT strain evaluation. METHODS Consecutive patientswith indication to mitral valve surgery for severe mitral regurgitation due to mitral valve prolapse were prospectively enrolled. CMR including Modified Look-Locker (MOLLI) sequences for T1 mapping was performed in each patient. In addition, CMR FT analysis of steady state free precession (SSFP) cine images was performed to obtain 2D global and segmental circumferential and radial strains. RESULTS 70 consecutive patients (age: 59 ± 12) were successfully evaluated with CMR. T1 native values were significantly higher in the basal and mid LV inferolateral wall compared to the remote myocardium (1074 ± 67 vs 1046 ± 40 msec, p< 0.001). Moreover, the average radial and circumferential strains of the basal and mid LV inferolateral were significantly reduced compared to those of the remote myocardium (21.1 ± 10.4 and -12.8 ± 5.6 vs 31.6 ± 9.1 and -17.3 ± 3.6 respectively, p < 0.001). CONCLUSIONS In patients with MVP and severe mitral regurgitation native T1 values of the LV inferolateral are higher as compared to remote myocardium and associated with reduced circumferential and radial strains. T1 mapping and CMR FT strain may be used as tools for the early identification of tissue changes in the LV inferolateral myocardial segment. Further studies are needed to evaluate if these changes are able to predict LGE development and are associated with higher risk for VAs

Identification of a high-risk subgroup with malignant mitral valve prolapse who are predisposed to sudden cardiac death. A Review

2020 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Ronald Russo ◽  
Abhishek Maan ◽  
Eirini Apostolidou ◽  
Arshia Khorasani-zadeh ◽  
Sean Byrnes ◽  
...  
Keyword(s):  
High Risk ◽  
Sudden Cardiac Death ◽  
Mitral Valve ◽  
Mitral Valve Prolapse ◽  
Cardiac Death

scholarly journals Arrhythmic Mitral Valve Prolapse and Sudden Cardiac Death

Circulation ◽  
2015 ◽  
Vol 132 (7) ◽  
pp. 556-566 ◽  
Author(s):  
Cristina Basso ◽  
Martina Perazzolo Marra ◽  
Stefania Rizzo ◽  
Manuel De Lazzari ◽  
Benedetta Giorgi ◽  
...  
Keyword(s):  
Sudden Cardiac Death ◽  
Mitral Valve ◽  
Mitral Valve Prolapse ◽  
Cardiac Death

scholarly journals Predictors of sudden cardiac arrest in adolescents with mitral valve prolapse: an analysis of the nationwide inpatient sample

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
B Narasimhan ◽  
L Wu ◽  
C.H Lucas ◽  
K Bhatia ◽  
A Shah ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Family History ◽  
Sudden Cardiac Death ◽  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Mitral Valve Prolapse ◽  
Cardiac Death ◽  
Sudden Cardiac Arrest ◽  
Adolescent Patients ◽  
History Of

Abstract Background Mitral valve prolapse (MVP) is the most commonly encountered valvular pathology seen in 2–3% of the general population. Though traditionally regarded as a benign pathology, recent literature suggests that sudden cardiac death is significantly more common in these patients with estimates of 0.2–0.4%/year. The exact underlying mechanism of these higher rates of SCD remain poorly understood. In this study, we aim to identify predictors of sudden cardiac arrest (SCA) in an adolescent population. Methods We conducted a retrospective study using the AHRQ-HCUP National Inpatient Sample 2016-2017 for the years 2016-17. All patients (≤18 years) admitted with Mitral valve prolapse were identified using ICD-10 codes and further sub stratified based on presence or absence of sudden cardiac arrest (SCA). Baseline characteristics were obtained and multivariate regression analysis was utilized to identify potential predictors of SCA. Independent risk factors for in-hospital mortality were identified using a proportional hazards model. Complications were defined as per the Agency for Health Care Research and Quality guideline. Results We screened a total of 71,473,874 admissions in the NIS database to identify a total of 1,372 adolescent patients admitted with MVP in the years 2016–17. These patients were then sub-categorized based on presence or absence of SCA during the hospitalization. Our findings revealed that patients with SCA were generally slightly older (15y vs 13y, p=0.036, OR-1.1, p=0.007) and more likely female (83.3% vs 13%, p=0.227, OR – 3.55, p=0.57)). Interestingly, patients in the SCA cohort were noted to have almost 4 fold higher rates of Mitral regurgitation (66.6% vs 18.35%, p=0.008, OR-8.89, p=0.005) as well as family history of SCD (16.7% vs 4.1%, p=0.145, OR-4.65, p=0.14). Conclusions Presence of Mitral regurgitation and a family history of sudden cardiac death are associated with significantly higher rates of SCA in adolescent patients with mitral valve prolapse. Predictors of SCA in Adolescent MVP Funding Acknowledgement Type of funding source: None

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