Sudden Cardiac Death in Mitral Valve Prolapse: Are we ready for Risk Stratification?

The data collected until recently was based on autopsy studies of SCD victims in whom MVP was the only pathologic cardiac finding, pointing for a specific subgroup of MVP patients, particularly women of younger age without significant MR as a risk group for SCD [1]. Otherwise, population-based studies looking into the natural history of asymptomatic MVP patients revealed an elevated 10-year all-cause mortality rate, predicted by significant MR and low LVEF; similar to the all-cause mortality reported in severe MR patients with a flail leaflet [2,3]. Nevertheless, these studies pointed for a subgroup of MVP patients experiencing SCD who were typically young and asymptomatic; many of whom had a preserved LVEF and no significant MR. Notably, although significant MR was found to predict ventricular arrhythmia among MVP patients in some studies [4,7] this was not shown by others [1-3,8].