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Prolapso aritmético de la válvula mitral y muerte cardíaca súbita
Cristina Basso1, Martina Perazzolo Marra2, Stefania Rizzo2
1From Departments of Cardiac, Thoracic, and Vascular Sciences (C.B., M.P.M., S.R., M.D.L., A.C., A.C.F., I.R. F.M., K.P., E.B., L.C., B.B., D.C., G.T., S.I.) and Radiology (B.G.), Azienda Ospedaliera-University of Padua Medical School, Padua, Italy. cristina.basso@unipd.it.
Circulation
|July 11, 2015
Resumen
El prolapso de la válvula mitral (MVP) es una causa significativa de muerte súbita cardíaca (SCD) en mujeres jóvenes. La fibrosis en el ventrículo izquierdo, particularmente en los músculos papilares, es la principal anomalía estructural relacionada con las arritmias ventriculares.
Área de la Ciencia:
- Cardiología Cardiología.
- Electrofisiología Cardíaca Electrofisiología cardíaca.
- Patología Patología Patología.
Sus antecedentes:
- El prolapso de la válvula mitral (MVP) puede conducir a arritmias ventriculares y muerte súbita cardíaca (SCD), incluso sin un compromiso hemodinámico significativo.
- Las causas estructurales subyacentes de esta inestabilidad eléctrica en MVP no se comprenden bien.
Objetivo del estudio:
- Para investigar la base estructural de las arritmias ventriculares y SCD en pacientes con MVP.
- Identificar biomarcadores de imágenes para la estratificación del riesgo en pacientes con MVP.
Principales métodos:
- Revisó un registro de patología cardíaca de 650 adultos jóvenes con SCD para identificar casos de MVP.
- Análisis histopatológico de corazones de pacientes con SCD con MVP.
- Imágenes de resonancia magnética cardíaca (CE-CMR) con contraste mejorado en pacientes vivos con MVP con y sin arritmias ventriculares complejas.
Principales resultados:
- MVP fue la única causa de SCD en el 7% de los adultos jóvenes, particularmente las mujeres (13%).
- La histología reveló fibrosis ventricular izquierda en los músculos papilares y en las paredes inferobasales en pacientes con SCD con MVP.
- CE-CMR mostró una mejora significativa del gadolinio tardío en pacientes MVP con arritmias (93%) en comparación con los controles (14%), con patrones de fibrosis que se superponen a la histopatología.
Conclusiones:
- MVP es una causa poco reconocida de SCD arritmica, especialmente en mujeres jóvenes.
- La fibrosis ventricular izquierda, particularmente en los músculos papilares y la pared inferobasal, es el sello estructural de MVP asociado con arritmias ventriculares.
- CE-CMR puede identificar este sustrato oculto para mejorar la estratificación del riesgo en pacientes con MVP.
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