{"doi":"10.1016/j.jacep.2021.01.007","title":"Pre- and Post-Mortem Characteristics of Lethal Mitral Valve Prolapse Among All Countywide Sudden Deaths","abstract":"OBJECTIVES: We sought to investigate the characteristics of mitral valve prolapse (MVP) in a postmortem study of consecutive sudden cardiac deaths (SCDs) up to age 90. BACKGROUND: Up to 2.3% of MVPs suffer SCD, but by convention SCD is rarely confirmed by autopsies. In a postmortem study of young persons < 40 years, 7% of SCDs were caused by MVP; bileaflet involvement, mitral annular disjunction (MAD), and replacement fibrosis were common. METHODS: In the San Francisco POST SCD Study, autopsies have been performed on >1000 consecutive WHO-defined (presumed) SCDs ages 18–90 since 2011, 603 adjudicated. Autopsy-defined sudden arrhythmic death (SAD) required absence of non-arrhythmic cause; MVP diagnosis required leaflet billowing. We reviewed 100 pre-mortem echocardiograms to identify additional MVPs missed on autopsy. RESULTS: Among 603 presumed SCDs, 339 (56%) were autopsy-defined SADs, with MVP identified in 7 (1%). We identified 6 additional MVPs by review of echocardiograms, for a prevalence of at least 2% among 603 presumed SCDs and 4% among 339 SADs (p = 0.02 vs 264 non-SADs). All 6 additional MVPs had monoleaflet rather than bileaflet involvement, and mild mitral regurgitation, ruling out hemodynamic cause. Less than half had MAD with replacement fibrosis, but all had multisite interstitial fibrosis. CONCLUSIONS: In a countywide postmortem study of all adult SCDs, MVP prevalence was at least 4% of SADs, but half were missed on autopsy. Monoleaflet MVP was often underdiagnosed postmortem. Compared to young SCDs, lethal MVP in older SCDs did not consistently have bileaflet anatomy, replacement fibrosis, or MAD.","journal":"JACC. Clinical electrophysiology","year":2020,"id":131711,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":0,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9624,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2020-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":585874,"name":"Sidney Aung","orcid":"0000-0002-7491-314X","position":1,"is_corresponding":false},{"id":252183,"name":"Eric Vittinghoff","orcid":"0000-0001-8535-0920","position":2,"is_corresponding":false},{"id":585875,"name":"Shiktij Dave","orcid":"0000-0003-0200-8965","position":3,"is_corresponding":false},{"id":585876,"name":"Lisa J. Lim","orcid":"0000-0002-8666-2843","position":4,"is_corresponding":false},{"id":901,"name":"Jeffrey E. Olgin","orcid":"0000-0003-1684-9327","position":5,"is_corresponding":false},{"id":270193,"name":"Andrew J. Connolly","orcid":"0000-0002-0660-3270","position":6,"is_corresponding":false},{"id":585877,"name":"Ellen Moffatt","orcid":"0000-0002-3804-3116","position":7,"is_corresponding":false},{"id":585878,"name":"Zian H. Tseng","orcid":"0000-0001-5996-4099","position":8,"is_corresponding":false},{"id":98913,"name":"Francesca N. Delling","orcid":"0000-0002-5224-4096","position":0,"is_corresponding":true}],"reference_count":0,"raw_metadata":null,"created_at":"2026-07-18T23:16:03.875886Z","pmid":null,"pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}