Muthukumar et al identified risk factors for the malignant arrhythmogenic phenotype of mitral valve prolapse (MVP). These can help to identify a patient who may benefit from more aggressive management. The authors are from the University of Wisconsin.
Patient selection: mitral valve prolapse
Clinical risk factors:
(1) young female
(2) palpitations
(3) syncope or presyncope
(4) family history of sudden cardiac death
Resting ECG changes:
(1) T-wave inversion in the inferior leads
(2) QT prolongation
(3) QT dispersion
(4) PVCs origination from the right ventricular outflow tract and papillary muscles
(5) nonsustained ventricular tachycardia or ventricular tachycardia
Exercise testing:
(1) polymorphic PVCs
(2) nonsustained ventricular tachycardia or ventricular tachycardia
MRI:
(1) left ventricular fibrosis on late gandolinium enhancement
(2) mitral annular dysfunction
(3) systolic curling
(4) basal lateral wall hypertrophy
Echocardiogram:
(1) mitral valve showing bileaflet involvement
(2) leaflet thickness > 5 mm
(3) mitral annular dysfunction
(4) moderate ot severe mitral regurgitation
(5) flail mitral leaflets
(6) Pickelhaube sign (increased velocities of the basal inferolateral tissue annulus)
(7) left ventricular mechanical dispersion
(8) increased regional postsystolic index in basal to midlateral wall
