Mitral valve prolapse and sudden cardiac death: A systematic review and meta-analysis

Chrishan J. Nalliah, Rajiv Mahajan, Adrian D. Elliott, Haris Haqqani, Dennis H. Lau, Jitendra K. Vohra, Joseph B. Morton, Christopher Semsarian, Thomas Marwick, Jonathan M. Kalman, Prash Sanders

Research output: Contribution to journalReview article

4 Citations (Scopus)

Abstract

Objectives Mitral valve prolapse (MVP) is commonly observed as a benign finding. However, the literature suggests that it may be associated with sudden cardiac death (SCD). We performed a meta-analysis and systematic review to determine the: (1) prevalence of MVP in the general population; (2) prevalence of MVP in all SCD and unexplained SCD; (3) incidence of SCD in MVP and (4) risk factors for SCD. Methods The English medical literature was searched for: (1) MVP community prevalence; (2) MVP prevalence in SCD cohorts; (3) incidence SCD in MVP and (4) SCD risk factors in MVP. Thirty-four studies were identified for inclusion. This study was registered with PROSPERO (CRD42018089502). Results The prevalence of MVP was 1.2% (95% CI 0.5 to 2.0) in community populations. Among SCD victims, the cause of death remained undetermined in 22.1% (95% CI 13.4 to 30.7); of these, MVP was observed in 11.7% (95% CI 5.8 to 19.1). The incidence of SCD in the MVP population was 0.14% (95% CI 0.1 to 0.3) per year. Potential risk factors for SCD include bileaflet prolapse, ventricular fibrosis complex ventricular ectopy and ST-T wave abnormalities. Conclusion The high prevalence of MVP in cohorts of unexplained SCD despite low population prevalence provides indirect evidence of an association of MVP with SCD. The absolute number of people exposed to the risk of SCD is significant, although the incidence of life-threatening arrhythmic events in the general MVP population remains low. High-risk features include bileaflet prolapse, ventricular fibrosis, ST-T wave abnormalities and frequent complex ventricular ectopy. Trial registration PROSPERO (CRD42018089502).

LanguageEnglish
Pages144-151
Number of pages8
JournalHeart
Volume105
Issue number2
DOIs
Publication statusPublished - 1 Jan 2019

Keywords

  • cardiac arrest
  • echocardiography
  • implanted cardiac defibrillators
  • premature ventricular beats
  • ventricular fibrillation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Nalliah, C. J., Mahajan, R., Elliott, A. D., Haqqani, H., Lau, D. H., Vohra, J. K., ... Sanders, P. (2019). Mitral valve prolapse and sudden cardiac death: A systematic review and meta-analysis. Heart, 105(2), 144-151. https://doi.org/10.1136/heartjnl-2017-312932
Nalliah, Chrishan J. ; Mahajan, Rajiv ; Elliott, Adrian D. ; Haqqani, Haris ; Lau, Dennis H. ; Vohra, Jitendra K. ; Morton, Joseph B. ; Semsarian, Christopher ; Marwick, Thomas ; Kalman, Jonathan M. ; Sanders, Prash. / Mitral valve prolapse and sudden cardiac death : A systematic review and meta-analysis. In: Heart. 2019 ; Vol. 105, No. 2. pp. 144-151.
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abstract = "Objectives Mitral valve prolapse (MVP) is commonly observed as a benign finding. However, the literature suggests that it may be associated with sudden cardiac death (SCD). We performed a meta-analysis and systematic review to determine the: (1) prevalence of MVP in the general population; (2) prevalence of MVP in all SCD and unexplained SCD; (3) incidence of SCD in MVP and (4) risk factors for SCD. Methods The English medical literature was searched for: (1) MVP community prevalence; (2) MVP prevalence in SCD cohorts; (3) incidence SCD in MVP and (4) SCD risk factors in MVP. Thirty-four studies were identified for inclusion. This study was registered with PROSPERO (CRD42018089502). Results The prevalence of MVP was 1.2{\%} (95{\%} CI 0.5 to 2.0) in community populations. Among SCD victims, the cause of death remained undetermined in 22.1{\%} (95{\%} CI 13.4 to 30.7); of these, MVP was observed in 11.7{\%} (95{\%} CI 5.8 to 19.1). The incidence of SCD in the MVP population was 0.14{\%} (95{\%} CI 0.1 to 0.3) per year. Potential risk factors for SCD include bileaflet prolapse, ventricular fibrosis complex ventricular ectopy and ST-T wave abnormalities. Conclusion The high prevalence of MVP in cohorts of unexplained SCD despite low population prevalence provides indirect evidence of an association of MVP with SCD. The absolute number of people exposed to the risk of SCD is significant, although the incidence of life-threatening arrhythmic events in the general MVP population remains low. High-risk features include bileaflet prolapse, ventricular fibrosis, ST-T wave abnormalities and frequent complex ventricular ectopy. Trial registration PROSPERO (CRD42018089502).",
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author = "Nalliah, {Chrishan J.} and Rajiv Mahajan and Elliott, {Adrian D.} and Haris Haqqani and Lau, {Dennis H.} and Vohra, {Jitendra K.} and Morton, {Joseph B.} and Christopher Semsarian and Thomas Marwick and Kalman, {Jonathan M.} and Prash Sanders",
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Nalliah, CJ, Mahajan, R, Elliott, AD, Haqqani, H, Lau, DH, Vohra, JK, Morton, JB, Semsarian, C, Marwick, T, Kalman, JM & Sanders, P 2019, 'Mitral valve prolapse and sudden cardiac death: A systematic review and meta-analysis', Heart, vol. 105, no. 2, pp. 144-151. https://doi.org/10.1136/heartjnl-2017-312932

Mitral valve prolapse and sudden cardiac death : A systematic review and meta-analysis. / Nalliah, Chrishan J.; Mahajan, Rajiv; Elliott, Adrian D.; Haqqani, Haris; Lau, Dennis H.; Vohra, Jitendra K.; Morton, Joseph B.; Semsarian, Christopher; Marwick, Thomas; Kalman, Jonathan M.; Sanders, Prash.

In: Heart, Vol. 105, No. 2, 01.01.2019, p. 144-151.

Research output: Contribution to journalReview article

TY - JOUR

T1 - Mitral valve prolapse and sudden cardiac death

T2 - Heart

AU - Nalliah, Chrishan J.

AU - Mahajan, Rajiv

AU - Elliott, Adrian D.

AU - Haqqani, Haris

AU - Lau, Dennis H.

AU - Vohra, Jitendra K.

AU - Morton, Joseph B.

AU - Semsarian, Christopher

AU - Marwick, Thomas

AU - Kalman, Jonathan M.

AU - Sanders, Prash

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Objectives Mitral valve prolapse (MVP) is commonly observed as a benign finding. However, the literature suggests that it may be associated with sudden cardiac death (SCD). We performed a meta-analysis and systematic review to determine the: (1) prevalence of MVP in the general population; (2) prevalence of MVP in all SCD and unexplained SCD; (3) incidence of SCD in MVP and (4) risk factors for SCD. Methods The English medical literature was searched for: (1) MVP community prevalence; (2) MVP prevalence in SCD cohorts; (3) incidence SCD in MVP and (4) SCD risk factors in MVP. Thirty-four studies were identified for inclusion. This study was registered with PROSPERO (CRD42018089502). Results The prevalence of MVP was 1.2% (95% CI 0.5 to 2.0) in community populations. Among SCD victims, the cause of death remained undetermined in 22.1% (95% CI 13.4 to 30.7); of these, MVP was observed in 11.7% (95% CI 5.8 to 19.1). The incidence of SCD in the MVP population was 0.14% (95% CI 0.1 to 0.3) per year. Potential risk factors for SCD include bileaflet prolapse, ventricular fibrosis complex ventricular ectopy and ST-T wave abnormalities. Conclusion The high prevalence of MVP in cohorts of unexplained SCD despite low population prevalence provides indirect evidence of an association of MVP with SCD. The absolute number of people exposed to the risk of SCD is significant, although the incidence of life-threatening arrhythmic events in the general MVP population remains low. High-risk features include bileaflet prolapse, ventricular fibrosis, ST-T wave abnormalities and frequent complex ventricular ectopy. Trial registration PROSPERO (CRD42018089502).

AB - Objectives Mitral valve prolapse (MVP) is commonly observed as a benign finding. However, the literature suggests that it may be associated with sudden cardiac death (SCD). We performed a meta-analysis and systematic review to determine the: (1) prevalence of MVP in the general population; (2) prevalence of MVP in all SCD and unexplained SCD; (3) incidence of SCD in MVP and (4) risk factors for SCD. Methods The English medical literature was searched for: (1) MVP community prevalence; (2) MVP prevalence in SCD cohorts; (3) incidence SCD in MVP and (4) SCD risk factors in MVP. Thirty-four studies were identified for inclusion. This study was registered with PROSPERO (CRD42018089502). Results The prevalence of MVP was 1.2% (95% CI 0.5 to 2.0) in community populations. Among SCD victims, the cause of death remained undetermined in 22.1% (95% CI 13.4 to 30.7); of these, MVP was observed in 11.7% (95% CI 5.8 to 19.1). The incidence of SCD in the MVP population was 0.14% (95% CI 0.1 to 0.3) per year. Potential risk factors for SCD include bileaflet prolapse, ventricular fibrosis complex ventricular ectopy and ST-T wave abnormalities. Conclusion The high prevalence of MVP in cohorts of unexplained SCD despite low population prevalence provides indirect evidence of an association of MVP with SCD. The absolute number of people exposed to the risk of SCD is significant, although the incidence of life-threatening arrhythmic events in the general MVP population remains low. High-risk features include bileaflet prolapse, ventricular fibrosis, ST-T wave abnormalities and frequent complex ventricular ectopy. Trial registration PROSPERO (CRD42018089502).

KW - cardiac arrest

KW - echocardiography

KW - implanted cardiac defibrillators

KW - premature ventricular beats

KW - ventricular fibrillation

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U2 - 10.1136/heartjnl-2017-312932

DO - 10.1136/heartjnl-2017-312932

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Nalliah CJ, Mahajan R, Elliott AD, Haqqani H, Lau DH, Vohra JK et al. Mitral valve prolapse and sudden cardiac death: A systematic review and meta-analysis. Heart. 2019 Jan 1;105(2):144-151. https://doi.org/10.1136/heartjnl-2017-312932