Cardiac Magnetic Resonance for the Prediction of Arrhythmic Events in Mitral Valve Prolapse: A Systematic Review and Meta-analysis.

Cardiac magnetic resonance (CMR) has gained ground in the assessment of mitral valve prolapse (MVP) patients. In this meta-analysis, we assessed the prognostic value of key CMR-derived imaging biomarkers -late gadolinium enhancement (LGE), mitral annular disjunction (MAD), and systolic curling- in patients with MVP. We also aimed to define the clinical and imaging features of patients with LGE on CMR. A total of 15 studies comprising 1,994 patients with MVP were included in this systematic review. All 3 MVP-related imaging biomarkers were significantly associated with increased risk of arrhythmic events (pooled RRs: 1.8, 95% CI 1.4 to 2.2, I2: 43% for LGE; 1.5, 95% CI 1.2 to 1.9, I2: 49% for MAD; 1.8, 95% CI 1.1 to 2.9, I2: 40% for curling). LGE demonstrated good predictive performance (Area under curve [AUC]: 0.76, 95% CI 0.72 to 0.80), with pooled sensitivity 0.75 (95% CI 0.57 to 0.87) and specificity 0.63 (95% CI 0.41 to 0.81) for life-threatening ventricular arrhythmias and sudden cardiac death. Additionally, according to our study, patients with LGE were older, had greater mitral regurgitation and more commonly MAD and bileaflet prolapse than those without LGE. In conclusion, CMR is an important tool for the risk stratification of patients with MVP; however, future studies should focus on clinical management pathways for LGE-positive patients with MVP.