Clinical Electrophysiology -> Ventricular Arrhythmias -> Mapping & Imaging D-PO01 - Featured Poster Session (ID 11) Poster

D-PO01-010 - Comparison Of Cardiac Magnetic Resonance Imaging (MRI) Findings In Malignant Vs. Non-malignant Mitral Valve Prolapse (MVP) (ID 38)


Background: Mitral valve prolapse (MVP) is a common valve condition that has been associated with ventricular arrhythmias with an “estimated annual risk of 0.2 to 1.9%.” Premature ventricular contractions (PVCs) from the papillary muscles (PMs) may play a role as triggers for malignant ventricular arrhythmias in these patients. Cardiac MRI can help define and characterize the composition of the myocardium and identify specific arrhythmic risk factors, such as late gadolinium enhancement (LGE) in the left ventricular infero-basal wall and papillary muscles.
Objective: To compare cardiac MRI findings such as LGE of the left ventricular infero-basal wall and papillary muscles findings in patients with malignant vs non-malignant MVP.
Methods: Single center records identified 39 patients with MVP who also had cardiac MRI imaging available for review. Patients were classified into two categories: malignant (12) vs. non-malignant phenotype (27). Malignant MVP included patients with papillary muscle PVCs with a burden identified on remote monitoring of greater than 20 percent, non-sustained (NS) or sustained ventricular tachycardia (VT) or those that had sudden cardiac death (SCD) not otherwise explained by another etiology. Cardiac MRI imaging was then reviewed to look for areas of LGE.
Results: Of 39 patients, 12 (4 males, 8 females) were identified with a malignant MVP phenotype. Average age was 61.7 years (range 39-77 years). 9 patients had PVCs (>20% burden)/NSVT, 2 patients had sustained VT and 1 had SCD. MRI findings identified LGE in areas including papillary muscle, inferobasal segment or mitral valve annulus in 9 patients (75%). 27 (10 males, 17 females) patients were identified as non-malignant phenotype. Average age was 57.6 years (range 16-78 years). Cardiac MRI imaging identified LGE in either the papillary muscle, inferobasal segment or mitral valve annulus in 6 patients (22.2%)
Conclusion: Papillary muscle, inferobasal segment or MV annulus LGE on cardiac MRI along with a significant PVC burden, NSVT, VT or SCD represents a higher risk phenotype in MVP patients. Cardiac MRI findings without significant ventricular arrhythmias may be able to predict a transition to a higher risk phenotype in these patients and closer monitoring may be of clinical benefit.