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Reunião Anual Conjunta dos Grupos de Estudo de Cirurgia Cardíaca, Doenças Valvulares e Ecocardiografia da SPC
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Mitral valve prolapse – Is it a defect or often just a feature?
Session:
Painel 3 - Imagiologia Cardiovascular 4
Speaker:
Pedro Alves Da Silva
Congress:
CPC 2020
Topic:
B. Imaging
Theme:
03. Imaging
Subtheme:
03.1 Echocardiography
Session Type:
Posters
FP Number:
---
Authors:
Pedro Alves Da Silva; Joana Rigueira; Inês Aguiar Ricardo; Rafael Santos; Afonso Nunes Ferreira; Tiago Graça Rodrigues; Nelson P. Cunha; Pedro Silvério António; Pedro Morais; Sara Couto Pereira; Rui Plácido; Cláudio David; Fausto José Pinto; Ana G. Almeida
Abstract
<p><strong>Introduction:</strong> Despite being known for more than a century, mitral valve prolapse (MVP) is an entity not fully understood with controversial data regarding the prognosis.</p> <p><strong>Objective:</strong> To characterize a sample of patients with MVP and to access the frequency of complications associated with MVP, hospital admissions and death.</p> <p><strong>Methods:</strong> Single-center retrospective study of consecutive patients with MVP documented in transthoracic echocardiogram between January 2014 and October 2019. MVP was defined as systolic displacement of the mitral leaflet into the left atrium≥ 2 mm from the mitral annular plane. Demographic, clinical, echocardiographic, electrocardiographic data were collected as well as major adverse events at follow-up. Categorical variables were reported in absolute number and/or percentage and continuous variables were reported as mean and standard deviation or median and interquartile range (IQR). The results were obtained using Chi-square and ANOVA tests.</p> <p><strong>Results:</strong> 247 patients were included (mean age 62.9 ± 18 years, 61% males). The mean diameter of the MVP was 6mm (IQR 5-9). The mean LVEF was 63% ± 6.3% and LV mass was 124,7 ± 41g/m2. Most of the patients were in sinus rhythm (78%). The posterior mitral valve leaflet (PL) was the most frequently involved (49%), followed by involvement of both leaflets (BL) (27%) and the anterior leaflet (AL) (25%). Patients with MVP of PL were older compared to patients with BL and AL involvement (68 ±15 vs 58±17 vs 59±22 years, respectively, p<0.001) and had longer QT interval (419 ± 35 vs 403 ± 25 vs 410 ± 34ms, respectively, p=0.013).</p> <p>Mitral annulus disjunction was present in 9.3% (n=23) of the patients, but this was not associated with more arrythmias or death. Only 6 patients didn’t have mitral regurgitation (MR), and 70.4% (174) had significant MR (moderate-severe or severe). 49% of the patients had symptoms (0.4% syncope, 5.7% pre-syncope, 18.6% palpitations, 5.1% chest pain and 49% dyspnea).</p> <p>During a mean follow-up of 30 ± 19 months, 25.1% of the patients had atrial fibrillation, 8 patients (3%) were submitted to supraventricular dysrhythmia ablation. 16.2% had premature ectopic ventricular complexes, 2.4% non-sustained VT, 0.4% sustained VT, 0.8% needed ICD, 8.5% had a pacemaker. 25% of the patients were submitted to mitral valve intervention (23.9% to surgical intervention and 3 to percutaneous). 12% of the patients had a hospital admission for cardiovascular cause and 8.5% of the patients died.</p> <p><strong>Conclusion:</strong> MVP was traditionally described as a benign entity. However, in our population it was associated with significant mitral regurgitation, some requiring intervention. Besides that, almost half of the patients were symptomatic and 44% had arrhythmias, with atrial fibrillation occurring in about 25%.</p>
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