title: Mitral valve prolapse and sudden cardiac arrest in the community.
abstract: BACKGROUND
  Mitral valve prolapse (MVP) is relatively common in the general population with recently reported prevalence of 1% and familial clustering (Framingham Heart Study). However, its association with ventricular arrhythmias and sudden cardiac arrest (SCA) remains controversial.
  
  
  OBJECTIVE
  The purpose of this study was to characterize the frequency and clinical profile of patients with MVP who suffer SCA in the community.
  
  
  METHODS
  Patients with SCA cases were prospectively identified in the population-based Oregon Sudden Unexpected Death Study (population ~1 million). The presence of MVP was identified from echocardiograms recorded prior but unrelated to the SCA event. The detailed clinical profile of patients with SCA and MVP was compared with that of SCA patients without MVP to identify potential differences.
  
  
  RESULTS
  A total of 729 SCA patients were evaluated over a 12-year period (mean age 69.5 ± 14.8 years; 64.6% men). MVP was observed in 17 (2.3%) prior to the SCA event (95% confidence interval 1.2%-3.4%). Mitral regurgitation was present in 14 SCA patients with MVP (82.3%) and was moderate or severe in 10 (58.8%). Compared with SCA patients without MVP, SCA patients with MVP were younger (mean age 60.9 ± 16.4 years vs 69.7 ± 14.7 years; P = .02), with fewer risk factors (diabetes 5.9% vs 46.4%; P = .001; hypertension 41.2% vs 78.9%; P = .001) or known coronary disease (29.4% vs 65.6%; P < .001).
  
  
  CONCLUSIONS
  MVP was observed in a small proportion (2.3%) of SCA patients in the general population, suggesting a low risk overall. Since SCA patients with MVP were characterized by younger age and relatively low cardiovascular comorbidity, a focus on imaging for valve structure/insufficiency as well as genetics could aid future risk stratification approaches.
authors.affiliation: The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: Kumar
authors.initials: K
authors.lastname: Narayanan
authors.affiliation: The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: Audrey
authors.initials: A
authors.lastname: Uy-Evanado
authors.affiliation: The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: Carmen
authors.initials: C
authors.lastname: Teodorescu
authors.affiliation: The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: Kyndaron
authors.initials: K
authors.lastname: Reinier
authors.affiliation: Center for Health Research, Kaiser Permanente, Portland, Oregon.
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Nichols
authors.affiliation: Department of Pathology, Oregon Health and Science University, Portland, Oregon.
authors.forename: Karen
authors.initials: K
authors.lastname: Gunson
authors.affiliation: Department of Emergency Medicine, Oregon Health and Science University, Portland, Oregon.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Jui
authors.affiliation: The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California. Electronic address: sumeet.chugh@cshs.org.
authors.forename: Sumeet S
authors.initials: SS
authors.lastname: Chugh
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D003324:Coronary Artery Disease / Q000453:epidemiology; D016757:Death, Sudden, Cardiac / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D004452:Echocardiography / Q000379:methods; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000503:physiopathology; D008944:Mitral Valve Insufficiency / Q000453:epidemiology; D008945:Mitral Valve Prolapse / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology; D009922:Oregon / Q000453:epidemiology; D015995:Prevalence; D018570:Risk Assessment; D012307:Risk Factors
keywords: Mitral valve prolapse; Risk; Sudden cardiac arrest