Title:Mitral Valve Prolapse and Sudden Cardiac Death in Athletes at High Risk
Volume: 19
Issue: 3
Author(s): Olga Vriz*, Irene Landi, Abdalla Eltayeb, Giuseppe Limongelli, Lucio Mos, Pietro Delise, Eduardo Bossone and Antonello D`Andrea
Affiliation:
- Heart Centre, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
Keywords:
Mitral valve, cardiac death, athletes, mitral valve prolapse, ventricular arrhythmias, premature ventricular contractions.
Abstract:
Mitral valve prolapse (MVP) is the most frequent valvulopathy in the general population,
with usually a favourable prognosis. Although it can be associated with some complications,
ventricular arrhythmias (VA) and sudden cardiac death (SCD) are the most worrying. The estimated
risk of SCD in MVP is between 0.2% to 1.9% per year, including MVP patients with and without
severe mitral regurgitation (MR). The association between SCD and MVP is expressed by a
phenotype called “malignant MVP” characterized by transthoracic echocardiography (TTE) findings
such as bileaflet myxomatous prolapse and mitral annulus disjunction (MAD), ECG findings
such as repolarization abnormalities, complex ventricular arrhythmias (c-VAs) and LV fibrosis of
papillary muscles (PMs) and inferobasal wall visualized by late gadolinium enhancement cardiac
magnetic resonance (LGE-CMR). Therefore, attention is raised for patients with “arrhythmic
MVP” characterized from an ECG point of view by frequent premature ventricular contractions
(PVCs) arising from one or both PMs as well as by T-wave inversion in the inferolateral leads. In
athletes, SCD is the most frequent medical cause of death and in young subjects (< 35 years) usually
is due to electrical mechanism affecting who has a silent cardiovascular disease and are not considered
per se a cause of increased mortality. In MVP, SCD was reported to happen during sports
activity or immediately after and valve prolapse was the only pathological aspect detected.
The aim of the present paper is to explore the association between SCD and MVP in athletes, focusing
attention on ECG, TTE in particular, and CMR findings that could help to identify subjects
at high risk for complex arrhythmias and eventually SCD. In addition, it is also examined if sports
activity might predispose patients with MVP to develop major arrhythmias.
