PRE- AND POSTMORTEM CHARACTERISTICS OF LETHAL MITRAL VALVE PROLAPSE AMONG ALL COUNTYWIDE SUDDEN DEATHS
| Autor: | Eric Vittinghoff, Sidney Aung, Lisa J. Lim, Ellen Moffatt, Jeffrey E. Olgin, Andrew J. Connolly, Zian H. Tseng, Francesca N. Delling, Shiktij Dave |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
Adult
medicine.medical_specialty Hemodynamics Autopsy 030204 cardiovascular system & hematology Interstitial fibrosis Article Sudden cardiac death 03 medical and health sciences Death Sudden 0302 clinical medicine Internal medicine medicine Mitral valve prolapse Humans 030212 general & internal medicine Aged Mitral regurgitation Mitral Valve Prolapse business.industry medicine.disease Arrhythmic death Death Sudden Cardiac Echocardiography Ventricular Fibrillation Cardiology Mitral Valve business Cardiac deaths |
| Zdroj: | JACC Clin Electrophysiol |
| Popis: | The goal of this study was to investigate the characteristics of mitral valve prolapse (MVP) in a post-mortem study of consecutive sudden cardiac deaths (SCDs) in subjects up to 90 years of age.Up to 2.3% of subjects with MVPs experience SCD, but by convention SCD is rarely confirmed by autopsy. In a post-mortem study of persons 40 years of age, 7% of SCDs were caused by MVP; bileaflet involvement, mitral annular disjunction (MAD), and replacement fibrosis were common.In the San Francisco POST SCD (Postmortem Systematic Investigation of Sudden Cardiac Death) study, autopsies have been performed on1,000 consecutive World Health Organization-defined (presumed) cases of SCD in subjects aged 18 to 90 years since 2011; a total of 603 were adjudicated. Autopsy-defined sudden arrhythmic death (SAD) required absence of nonarrhythmic cause; MVP diagnosis required leaflet billowing. One hundred antemortem echocardiograms were revised to identify additional MVPs missed on autopsy.Among the 603 presumed SCDs, 339 (56%) were autopsy-defined SADs, with MVP identified in 7 (1%). Six additional MVPs were identified by review of echocardiograms, for a prevalence of at least 2% among 603 presumed SCDs and 4% among 339 SADs (vs. 264 non-SADs; p = 0.02). All 6 additional MVPs had monoleaflet rather than bileaflet involvement and mild mitral regurgitation, ruling out hemodynamic cause. Less than one-half had MAD with replacement fibrosis, but all had multisite interstitial fibrosis.In a countywide post-mortem study of all adult cases of SCD, MVP prevalence was at least 4% of SADs, but one-half were missed on autopsy. Monoleaflet MVP was often underdiagnosed post-mortem. Compared with young cases of SCD, lethal MVP in older cases of SCD did not consistently have bileaflet anatomy, replacement fibrosis, or MAD. |
| Databáze: | OpenAIRE |
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