RESUMEN
PURPOSE OF THE REVIEW: To summarize currently available data on the topic of mitral valve prolapse (MVP) and its correlation to the occurrence of atrial and ventricular arrhythmias. To assess the prognostic value of several diagnostic methods such as transthoracic echocardiography, transesophageal echocardiography, cardiac magnetic resonance, cardiac computed tomography, electrocardiography, and electrophysiology concerning arrhythmic episodes. To explore intra and extracellular biochemistry of the cardiovascular system and its biomarkers as diagnostic tools to predict rhythm disturbances in the MVP population. RECENT FINDINGS: MVP is a common and mainly benign valvular disorder. It affects 2-3% of the general population. MVP is a heterogeneous and highly variable phenomenon with three structural phenotypes: myxomatous degeneration, fibroelastic deficiency, and forme fruste. Exercise intolerance, supraventricular tachycardia, and chest discomfort are the symptoms that are often paired with psychosomatic components. Though MVP is thought to be benign, the association between isolated MVP without mitral regurgitation (MR) or left ventricle dysfunction, with ventricular arrhythmia (VA) and sudden cardiac death (SCD) has been observed. The incidence of SCD in the MVP population is around 0.6% per year, which is 6 times higher than the occurrence of SCD in the general population. Often asymptomatic MVP population poses a challenge to screen for VA and prevent SCD. Therefore, it is crucial to carefully assess the risk of VA and SCD in patients with MVP with the use of various tools such as diagnostic imaging and biochemical and genetic screening.
Asunto(s)
Biomarcadores , Muerte Súbita Cardíaca , Prolapso de la Válvula Mitral , Humanos , Prolapso de la Válvula Mitral/complicaciones , Prolapso de la Válvula Mitral/diagnóstico por imagen , Prolapso de la Válvula Mitral/fisiopatología , Muerte Súbita Cardíaca/epidemiología , Biomarcadores/sangre , Arritmias Cardíacas/fisiopatología , Electrocardiografía , Pronóstico , Ecocardiografía , Factores de RiesgoRESUMEN
The aim of this study was to evaluate the influence of sex on cardiovascular hemodynamics and heart remodeling in 144 patients with arterial hypertension that underwent: (1) echocardiography (that is, indices of left ventricular diastolic function: e', E/e'), (2) impedance cardiography (that is, systemic vascular resistance (SVR), total artery compliance (TAC) and Heather index (HI)) and (3) applanation tonometry (augmentation index (AI), central systolic and diastolic blood pressure (CSBP, CDBP), central pulse pressure (CPP)). Women, in comparison with men, revealed to have: (1) stiffer arteries--lower TAC (1.93±0.55 vs 2.16±0.59 ml per mm Hg; P=0.025), higher CSBP (128.7±14.9 vs 123.4±13.2 mm Hg; P=0.036), CPP (39.9±9.5 vs 33.8±9.0 mm Hg; P=0.0002), AI (31.5±8.7 vs 17.5±12.7%; P<0.00001), SVR (1257.6±305.6 vs 1091.2±240.7 dyn × s × cm(-)(5); P=0.002) and (2) higher left ventricular performance--HI (16.3±4.3 vs 11.7±3.2 Ohm × s(2); P<0.00001). In women CSBP, CPP and AI were more clearly associated with left ventricular filling pressure (e') (r=-0.39, r=-0.45, r=-0.44, P<0.01; respectively). These relations were remarkably weaker in men. Hypertensive women characterized with lower large artery compliance, more pronounced augmentation of central blood pressure and more distinctive association of central blood pressure with left ventricular diastolic function. Sex differences in cardiovascular function can impact the individualized management of arterial hypertension.