Diagnosis of Mitral Valve Prolapse: Much More than Simple Prolapse. Multimodality Approach to Risk Stratification and Therapeutic Management
Mitral valve prolapse (MVP) is the most common valvular disease with a prevalence of 2%. It has generally a benign course; however, recent findings suggested an association between MVP and complex arrhythmias and eventually cardiac arrest and for this reason, it is also called arrhythmogenic MVP. Su...
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| Format: | Article |
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MDPI AG
2022-01-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/11/2/455 |
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| author | Ali Alenazy Abdalla Eltayeb Muteb K. Alotaibi Muhammah Kashif Anwar Norah Mulafikh Mohammed Aladmawi Olga Vriz |
| author_facet | Ali Alenazy Abdalla Eltayeb Muteb K. Alotaibi Muhammah Kashif Anwar Norah Mulafikh Mohammed Aladmawi Olga Vriz |
| author_sort | Ali Alenazy |
| collection | DOAJ |
| description | Mitral valve prolapse (MVP) is the most common valvular disease with a prevalence of 2%. It has generally a benign course; however, recent findings suggested an association between MVP and complex arrhythmias and eventually cardiac arrest and for this reason, it is also called arrhythmogenic MVP. Subjects who experience this complication are in general young women, with thickened mitral leaflets or bileaflet prolapse not necessarily associated with severe mitral regurgitation (MR). The nature of the relation between MVP and cardiac arrest is not clearly understood. Actually, the challenging task is to find the cluster of prognostic factors including T-wave inversion, polymorphic premature ventricular contractions, bileaflet prolapse, MR severity, but most importantly, those parameters of hypercontractility, mitral annulus disjunction (MAD), and myocardial fibrosis using a multimodality approach. Transthoracic echocardiography is the first-line imaging modality for the diagnosis of MVP, but also for detecting MAD and hypercontractility, followed by cardiac magnetic resonance for tissue characterization and detection of myocardial and papillary muscle fibrosis, using either late gadolinium enhancement (at the basal segment of the inferolateral wall and papillary muscles) (macro-fibrosis), or diffuse fibrosis by T1 mapping (native and post contrast T1). Moreover, there are also preliminary data on positron emission tomography utilizing <sup>18</sup>F-fluorodeoxyglucose as a tool for providing evidence of early myocardial inflammation. The objective of this review article is to provide the clinician with an overview and a practical clinical approach to MVP for risk stratification and treatment guidance. |
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| language | English |
| last_indexed | 2024-03-10T01:13:27Z |
| publishDate | 2022-01-01 |
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| series | Journal of Clinical Medicine |
| spelling | doaj.art-b95b79e3ebf34b17b1cee2e1ceef09e02023-11-23T14:14:20ZengMDPI AGJournal of Clinical Medicine2077-03832022-01-0111245510.3390/jcm11020455Diagnosis of Mitral Valve Prolapse: Much More than Simple Prolapse. Multimodality Approach to Risk Stratification and Therapeutic ManagementAli Alenazy0Abdalla Eltayeb1Muteb K. Alotaibi2Muhammah Kashif Anwar3Norah Mulafikh4Mohammed Aladmawi5Olga Vriz6Heart Centre, King Faisal Specialist Hospital & Research Centre, Riyadh 11211, Saudi ArabiaHeart Centre, King Faisal Specialist Hospital & Research Centre, Riyadh 11211, Saudi ArabiaRadiology Department, King Faisal Specialist Hospital & Research Centre, Riyadh 11211, Saudi ArabiaHeart Centre, King Faisal Specialist Hospital & Research Centre, Riyadh 11211, Saudi ArabiaRadiology Department, King Faisal Specialist Hospital & Research Centre, Riyadh 11211, Saudi ArabiaHeart Centre, King Faisal Specialist Hospital & Research Centre, Riyadh 11211, Saudi ArabiaHeart Centre, King Faisal Specialist Hospital & Research Centre, Riyadh 11211, Saudi ArabiaMitral valve prolapse (MVP) is the most common valvular disease with a prevalence of 2%. It has generally a benign course; however, recent findings suggested an association between MVP and complex arrhythmias and eventually cardiac arrest and for this reason, it is also called arrhythmogenic MVP. Subjects who experience this complication are in general young women, with thickened mitral leaflets or bileaflet prolapse not necessarily associated with severe mitral regurgitation (MR). The nature of the relation between MVP and cardiac arrest is not clearly understood. Actually, the challenging task is to find the cluster of prognostic factors including T-wave inversion, polymorphic premature ventricular contractions, bileaflet prolapse, MR severity, but most importantly, those parameters of hypercontractility, mitral annulus disjunction (MAD), and myocardial fibrosis using a multimodality approach. Transthoracic echocardiography is the first-line imaging modality for the diagnosis of MVP, but also for detecting MAD and hypercontractility, followed by cardiac magnetic resonance for tissue characterization and detection of myocardial and papillary muscle fibrosis, using either late gadolinium enhancement (at the basal segment of the inferolateral wall and papillary muscles) (macro-fibrosis), or diffuse fibrosis by T1 mapping (native and post contrast T1). Moreover, there are also preliminary data on positron emission tomography utilizing <sup>18</sup>F-fluorodeoxyglucose as a tool for providing evidence of early myocardial inflammation. The objective of this review article is to provide the clinician with an overview and a practical clinical approach to MVP for risk stratification and treatment guidance.https://www.mdpi.com/2077-0383/11/2/455mitral valve prolapsemitral annulus disjunctionmyocardial fibrosiscomplex ventricular arrhythmiascardiac magnetic resonanceechocardiography |
| spellingShingle | Ali Alenazy Abdalla Eltayeb Muteb K. Alotaibi Muhammah Kashif Anwar Norah Mulafikh Mohammed Aladmawi Olga Vriz Diagnosis of Mitral Valve Prolapse: Much More than Simple Prolapse. Multimodality Approach to Risk Stratification and Therapeutic Management Journal of Clinical Medicine mitral valve prolapse mitral annulus disjunction myocardial fibrosis complex ventricular arrhythmias cardiac magnetic resonance echocardiography |
| title | Diagnosis of Mitral Valve Prolapse: Much More than Simple Prolapse. Multimodality Approach to Risk Stratification and Therapeutic Management |
| title_full | Diagnosis of Mitral Valve Prolapse: Much More than Simple Prolapse. Multimodality Approach to Risk Stratification and Therapeutic Management |
| title_fullStr | Diagnosis of Mitral Valve Prolapse: Much More than Simple Prolapse. Multimodality Approach to Risk Stratification and Therapeutic Management |
| title_full_unstemmed | Diagnosis of Mitral Valve Prolapse: Much More than Simple Prolapse. Multimodality Approach to Risk Stratification and Therapeutic Management |
| title_short | Diagnosis of Mitral Valve Prolapse: Much More than Simple Prolapse. Multimodality Approach to Risk Stratification and Therapeutic Management |
| title_sort | diagnosis of mitral valve prolapse much more than simple prolapse multimodality approach to risk stratification and therapeutic management |
| topic | mitral valve prolapse mitral annulus disjunction myocardial fibrosis complex ventricular arrhythmias cardiac magnetic resonance echocardiography |
| url | https://www.mdpi.com/2077-0383/11/2/455 |
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