Mitral Valve Prolapse and Sudden Cardiac Death in Athletes at High Risk.

Area of Science:

• Cardiology
• Sports Medicine
• Cardiac Electrophysiology

Background:

• Mitral valve prolapse (MVP) is a common valvulopathy with a generally favorable prognosis.
• However, MVP can be associated with serious complications, including ventricular arrhythmias (VA) and sudden cardiac death (SCD), with an estimated annual risk of 0.2%–1.9%.
• A subset of MVP patients, termed "malignant MVP," exhibits specific imaging and ECG characteristics linked to increased SCD risk.

Purpose of the Study:

• To explore the association between sudden cardiac death (SCD) and mitral valve prolapse (MVP) specifically in athletes.
• To identify key electrocardiogram (ECG), transthoracic echocardiography (TTE), and cardiac magnetic resonance (CMR) findings that indicate high risk for complex arrhythmias and SCD in athletes with MVP.
• To examine whether sports participation may predispose MVP patients to major arrhythmias.

Main Methods:

• Review of existing literature on MVP, SCD, and athletic participation.
• Analysis of characteristic findings from TTE (e.g., bileaflet myxomatous prolapse, mitral annulus disjunction) and ECG (e.g., repolarization abnormalities, premature ventricular contractions, T-wave inversion).
• Correlation of these findings with cardiac magnetic resonance (CMR) evidence of left ventricular (LV) fibrosis, particularly in papillary muscles and the inferobasal wall.

Main Results:

• The "malignant MVP" phenotype includes specific TTE findings and ECG abnormalities like frequent premature ventricular contractions (PVCs) from papillary muscles and inferolateral T-wave inversions.
• Cardiac magnetic resonance (CMR) can reveal LV fibrosis in papillary muscles and the inferobasal wall in affected individuals.
• Sudden cardiac death in MVP patients, especially athletes, has been reported during or immediately after sports activity.

Conclusions:

• Athletes with MVP exhibiting specific ECG and TTE findings, such as "arrhythmic MVP" or "malignant MVP" phenotypes, may be at higher risk for SCD.
• Advanced imaging like CMR can further stratify risk by identifying myocardial fibrosis.
• Further research is needed to fully understand the role of sports activity in precipitating arrhythmias in MVP patients.