背景:最近,一项专家共识声明提出,二尖瓣脱垂(MVP)患者植入一级预防植入式心律转复除颤器(ICD)可能是合理的适应症.目的是通过专家共识声明评估拟议的风险分层。
方法:将无替代性心律失常基质的连续MVP患者进行心脏磁共振成像(CMR)纳入单中心回顾性登记。心律失常MVP(AMVP)定义为室性早搏总负荷≥5%,非持续性室性心动过速(VT),VT,或者心室纤颤.终点是SCD的复合,VT,诱导型室性心动过速,和适当的ICD冲击。
结果:总计,169名患者(52.1%为男性,中位年龄51.4岁),99(58.6%)被归类为AMVP.多变量逻辑回归将钆晚期增强(OR2.82,95CI1.45-5.50)和二尖瓣环分离(OR1.98,95CI1.02-3.86)的存在确定为AMVP的唯一预测因子。根据EHRA风险分层,5例AMVP患者(5.1%)有二级预防ICD指征,而在69例患者(69.7%)中,植入ICD可能是合理的。在8.0年的中位随访期间(IQR5.0-15.6),复合心律失常终点的发生率为0.3%/年(95CI0.1-0.8).
结论:接受CMR转诊的MVP患者中有一半以上符合AMVP诊断标准。尽管长期事件发生率很低,在70%的AMVP患者中,植入ICD可能是合理的.MVP中SCD的风险分层仍然是一个重要的知识空白,需要紧急调查。
Recently, an expert
consensus statement proposed indications where implantation of a primary prevention implantable cardioverter-defibrillator (ICD) may be reasonable in patients with mitral valve prolapse (MVP). The objective was to evaluate the proposed risk stratification by the expert
consensus statement.
Consecutive patients with MVP without alternative arrhythmic substrates with cardiac magnetic resonance imaging (CMR) were included in a single-center retrospective registry. Arrhythmic MVP (AMVP) was defined as a total premature ventricular complex burden ≥5%, non-sustained ventricular tachycardia (VT), VT, or ventricular fibrillation. The end point was a composite of SCD, VT, inducible VT, and appropriate ICD shocks.
In total, 169 patients (52.1% male, median age 51.4 years) were included and 99 (58.6%) were classified as AMVP. Multivariate logistic regression identified the presence of late gadolinium enhancement (OR 2.82, 95%CI 1.45-5.50) and mitral annular disjunction (OR 1.98, 95%CI 1.02-3.86) as only predictors of AMVP. According to the EHRA risk stratification, 5 patients with AMVP (5.1%) had a secondary prevention ICD indication, while in 69 patients (69.7%) the implantation of an ICD may be reasonable. During a median follow-up of 8.0 years (IQR 5.0-15.6), the incidence rate for the composite arrhythmic end point was 0.3%/year (95%CI 0.1-0.8).
More than half of MVP patients referred for CMR met the AMVP diagnostic criteria. Despite low long-term event rates, in 70% of patients with AMVP the implantation of an ICD may be reasonable. Risk stratification of SCD in MVP remains an important knowledge gap and requires urgent investigation.