Determinants and prognostic significance of focal myocardial fibrosis by cardiac magnetic resonance imaging in patients with mitral valve prolapse

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A.L Constant Dit Beaufils ◽  
O Huttin ◽  
N Piriou ◽  
C Cueff ◽  
T Senage ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Mitral Valve ◽  
Mitral Valve Prolapse ◽  
Prognostic Significance ◽  
Multivariable Analysis ◽  
Funding Source ◽  
Arterial Embolism ◽  
Cmr Imaging

Abstract Background Mitral valve prolapse (MVP) is a frequent disease that can be complicated by mitral regurgitation (MR), heart failure, arterial embolism, rhythm disorders and death. Purpose We sought to evaluate the correlates of late gadolinium enhancement (LGE), and the prognostic significance of ventricular size, function, and LGE by cardiac magnetic resonance (CMR) imaging on cardiovascular morbi-mortality in patients with MVP Methods We included 426 patients (54±15 years, 57% male) with MVP (trace to severe MR) between 2010 and 2019 who underwent a comprehensive echocardiography and CMR imaging. Gadolinium was injected in 411 (96%) patients. The main outcome endpoint was a composite endpoint of cardiovascular death, heart failure, new onset atrial fibrillation or arterial embolism, censored at the time of mitral valve intervention. Results Among the 411 patients, LGE+ was found in 118 (29%; 100 myocardial wall including 78 basal inferolateral midwall, 30 papillary muscles) and was more frequent with worse MR volume and LV remodeling. Correlates of LGE in multivariable analysis were LV mass index (OR 1.02, P=0.008), moderate-severe MR (OR 2.15, P=0.017) and coronary artery disease (OR 5.8, P=0.013). At 4 years, survival without cardiovascular events was decreased in patients with LGE+ (50.0±11.9 vs 73.5±6.3%, p<0.0001). In a stepwise multivariable analysis including classical predictors of outcome, grade of MR, LA volume index and the presence of LGE on CMR imaging (HR: 2.15 [1.15–4.02], P=0.017) were associated with impaired event-free survival. Conclusion CMR imaging provides additional information to echocardiography in the clinical work-up of MVP. Localized LV myocardial fibrosis is a predictor of cardiovascular event in MVP patients. Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): DGOS (PHRCI), Fondation Cœur et Recherche

scholarly journals Replacement Myocardial Fibrosis in Patients with Mitral Valve Prolapse: Relation to Mitral Regurgitation, Ventricular Remodeling and Arrhythmia

Circulation ◽  
2021 ◽  
Author(s):  
Anne-Laure Constant Dit Beaufils ◽  
Olivier Huttin ◽  
Antoine Jobbe-Duval ◽  
Thomas Senage ◽  
Laura Filippetti ◽  
...  
Keyword(s):  
Heart Failure ◽  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Ventricular Arrhythmia ◽  
Myocardial Fibrosis ◽  
Mitral Valve Prolapse ◽  
Cardiovascular Events ◽  
Prognostic Significance ◽  
Left Ventricular ◽  
Arterial Embolism

Background: Mitral valve prolapse (MVP) is a frequent disease that can be complicated by mitral regurgitation (MR), heart failure, arterial embolism, rhythm disorders and death. Left ventricular (LV) replacement myocardial fibrosis, a marker of maladaptive remodeling, has been described in patients with MVP, but the implications of this finding remain scarcely explored. We aimed at assessing the prevalence, pathophysiological and prognostic significance of LV replacement myocardial fibrosis through late gadolinium enhancement (LGE) by cardiac magnetic resonance (CMR) in patients with MVP. Methods: Four hundred patients (53±15 years, 55% male) with MVP (trace to severe MR by echocardiography) from 2 centers, who underwent a comprehensive echocardiography and LGE CMR, were included. Correlates of replacement myocardial fibrosis (LGE+), influence of MR degree, and ventricular arrhythmia were assessed. The primary outcome was a composite of cardiovascular events (cardiac death, heart failure, new-onset atrial fibrillation, arterial embolism, and life-threatening ventricular arrhythmia). Results: Replacement myocardial fibrosis (LGE+) was observed in 110 patients (28%; 91 myocardial wall including 71 basal inferolateral wall, 29 papillary muscle). LGE+ prevalence was 13% in trace-mild MR, 28% in moderate and 37% in severe MR, and was associated with specific features of mitral valve apparatus, more dilated LV and more frequent ventricular arrhythmias (45 vs 26%, P<0.0001). In trace-mild MR, despite the absence of significant volume overload, abnormal LV dilatation was observed in 16% of patients and ventricular arrhythmia in 25%. Correlates of LGE+ in multivariable analysis were LV mass (OR 1.01, 95% CI [1.002-1.017], P=0.009) and moderate-severe MR (OR: 2.28, 95% CI [1.21-4.31], P=0.011). LGE+ was associated with worse 4-year cardiovascular event-free survival (49.6±11.7 in LGE+ vs 73.3±6.5% in LGE-, P<0.0001). In a stepwise multivariable Cox model, MR volume and LGE+ (HR: 2.6 [1.4-4.9], P=0.002) were associated with poor outcome. Conclusions: LV replacement myocardial fibrosis is frequent in patients with MVP, is associated with mitral valve apparatus alteration, more dilated LV, MR grade, ventricular arrhythmia, and is independently associated with cardiovascular events. These findings suggest a MVP-related myocardial disease. Finally, CMR provides additional information to echocardiography in MVP.

T1 mapping and cardiac magnetic resonance feature tracking in mitral valve prolapse

2020 ◽  
Author(s):  
Marco Guglielmo ◽  
Laura Fusini ◽  
Giuseppe Muscogiuri ◽  
Francesca Baessato ◽  
Antonella Loffreno ◽  
...  
Keyword(s):  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Mitral Valve ◽  
Mitral Valve Prolapse ◽  
Feature Tracking ◽  
T1 Mapping

Cardiac magnetic resonance in patients with mitral valve prolapse: Focus on late gadolinium enhancement and T1 mapping

2018 ◽  
Vol 29 (3) ◽  
pp. 1546-1554 ◽  
Author(s):  
Silvia Pradella ◽  
Giulia Grazzini ◽  
Marta Brandani ◽  
Linda Calistri ◽  
Cosimo Nardi ◽  
...  
Keyword(s):  
Cardiac Magnetic Resonance ◽  
Late Gadolinium Enhancement ◽  
Magnetic Resonance ◽  
Mitral Valve ◽  
Mitral Valve Prolapse ◽  
T1 Mapping ◽  
Gadolinium Enhancement

scholarly journals 1046 Prognostic value of cardiac magnetic resonance imaging in mitral valve prolapse

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
A L Bouttier ◽  
A Jobbe-Duval ◽  
C Cueff ◽  
N Piriou ◽  
P Jaafar ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiac Magnetic Resonance ◽  
Mitral Regurgitation ◽  
Prognostic Value ◽  
Severe Mitral Regurgitation ◽  
Event Free Survival ◽  
Arterial Embolism ◽  
Free Survival ◽  
Lv Mass ◽  
Cmr Imaging

Abstract Background Mitral valve prolapse (MVP) is a frequent pathology that can be complicated by mitral regurgitation, heart failure, rhythm disorders, arterial embolism and death. The aim of this study was to evaluate the prognostic interest of ventricular volumes, right ventricular ejection fraction (RVEF) and late gadolinium enhancement (LGE) assessed by cardiac magnetic resonance (CMR) imaging on cardiovascular morbi-mortality in a cohort of patients with MVP Methods We examined the prognostic value of CMR imaging in 237 patients with MVP (no to severe mitral regurgitation) included between 2010 and 2019. All patients underwent a comprehensive echocardiography. The main endpoint was a composite endpoint of cardiovascular death, heart failure, new onset atrial fibrillation, arterial embolism. Results Among the 237 patients (63% male), 97 (41%) had LGE (75 myocardial wall, 10 papillary muscle tip and 12 both locations). Factors associated with LGE in multivariable analysis were age (OR 1.02, P = 0.037), left ventricular (LV) mass (OR 1.01, P = 0.008) and pulmonary artery systolic pressure (PAPS, OR 1.02, P = 0.069). Follow-up was censored at the time of surgery or percutaneous repair. In univariate analysis NYHA class, LV mass, left atrial volume, PAPS, LV end-diastolic and end-systolic volumes, chordal rupture and MR degree were associated with outcome. RVEF and biventricular dysfunction (LV EF &lt; 60% and RV EF &lt; 40%) were also associated with impaired event-free survival (36.0 ± 17.0% vs 65.4± 5.8%, P = 0.019). Finally, LGE was associated with a decreased event-free survival (55.6 ± 9.9% vs 70.7± 6.9%, P = 0.002). In multivariablee analysis, moderate to severe mitral regurgitation (HR : 2.14 [1.44-3.19], P &lt; 0.0001) and the presence of LGE were predictors of impaired event-free survival (HR : 2.12 [1.08-4.16], P = 0.003). Conclusion CMR imaging provides additional prognostic information to echocardiography in the study of MVP. Myocardial fibrosis of the left ventricle and right ventricular function as assessed by CMR imaging are predictors of cardiovascular morbidity and mortality in MVP.

scholarly journals Mitral Valve Prolapse, Ventricular Arrhythmias, and Sudden Death

Circulation ◽  
2019 ◽  
Vol 140 (11) ◽  
pp. 952-964 ◽  
Author(s):  
Cristina Basso ◽  
Sabino Iliceto ◽  
Gaetano Thiene ◽  
Martina Perazzolo Marra
Keyword(s):  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Mitral Valve ◽  
Sudden Death ◽  
Mitral Valve Prolapse ◽  
Ventricular Arrhythmias ◽  
Left Ventricular ◽  
Premature Ventricular Beats ◽  
Electrophysiologic Studies

Despite a 2% to 3% prevalence of echocardiographically defined mitral valve prolapse (MVP) in the general population, the actual burden, risk stratification, and treatment of the so-called arrhythmic MVP are unknown. The clinical profile is characterized by a patient, usually female, with mostly bileaflet myxomatous disease, mid-systolic click, repolarization abnormalities in the inferior leads, and complex ventricular arrhythmias with polymorphic/right bundle branch block morphology, without significant regurgitation. Among the various pathophysiologic mechanisms of electrical instability, left ventricular fibrosis in the papillary muscles and inferobasal wall, mitral annulus disjunction, and systolic curling have been recently described by pathological and cardiac magnetic resonance studies in sudden death victims and patients with arrhythmic MVP. In addition, premature ventricular beats arising from the Purkinje tissue as ventricular fibrillation triggers have been documented by electrophysiologic studies in MVP patients with aborted sudden death. The genesis of malignant ventricular arrhythmias in MVP probably recognizes the combination of the substrate (regional myocardial hypertrophy and fibrosis, Purkinje fibers) and the trigger (mechanical stretch) eliciting premature ventricular beats because of a primary morphofunctional abnormality of the mitral valve annulus. The main clinical challenge is how to identify patients with arrhythmic MVP (which imaging technique and in which patient) and how to treat them to prevent sudden death. Thus, there is a necessity for prospective multicenter studies focusing on the prognostic role of cardiac magnetic resonance and electrophysiologic studies and on the therapeutic efficacy of targeted catheter ablation and mitral valve surgery in reducing the risk of life-threatening arrhythmias, as well as the role of implantable cardioverter defibrillators for primary prevention.

scholarly journals Impact of right ventricular volume and function assessed by cardiac magnetic resonance imaging on outcomes in patients undergoing MitraClip implantation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Spieker ◽  
J Marpert ◽  
S Afzal ◽  
A Karathanos ◽  
D Scheiber ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiac Magnetic Resonance ◽  
Mitral Valve ◽  
Right Ventricular ◽  
Systolic Dysfunction ◽  
Poor Clinical Outcome ◽  
All Cause Mortality ◽  
And Function ◽  
Cmr Imaging

Abstract Background Right ventricular (RV) dysfunction is a predictor of poor clinical outcome in patients with heart failure and valvular heart disease. However, in patients undergoing MitraClip implantation, only limited data exist regarding the prognostic role of RV function and dimensions on outcomes. Previous studies suggested that RV dysfunction may be associated with poor clinical outcome following MitraClip, while other studies demonstrated contractionary results. Purpose The purpose of this study was to assess whether cardiac magnetic resonance (CMR) imaging derived RV assessment can facilitate risk stratification among patients undergoing transcatheter mitral valve repair with the MitraClip. Methods Sixty-one patients (mean age 77±9 years; 72% functional MR; logistic EuroScore 24±15) with severe mitral regurgitation (MR) were included and underwent CMR imaging and right heart catheterization prior MitraClip procedure. We divided patients into groups according to the presence of RV systolic dysfunction defined by RV ejection fraction (RVEF) &lt;45%. Similarly, patients were separated into groups according to the presence of RV dilatation. For the assessment of RV dilatation, the RV end-diastolic volume index (RVEDVi) assessed by CMR was matched to age and gender specific reference values for each patient. All-cause mortality was assessed during one-year follow-up. Results Patients with RV systolic dysfunction displayed increased left and right ventricular volumes as well as reduced LVEF (all p&lt;0.05). Patients with RV dilatation showed increased left atrial area index (p=0.012) and had more advanced tricuspid regurgitation (p=0.028). Moreover, we observed a negative correlation between RVEDVi and PAPi (r=−0.231, p=0.087) and a positive correlation between RVEDVi and the ratio of right atrial (RA) pressure/ pulmonary artery wedge pressure (PAWP) (r=0.278, p=0.043). We found an inverse correlation between RVEF and systolic pulmonary artery pressure (r=−0.329, p=0.012) (Figure 3). During 12±1 month follow-up, 15 patients (25%) died. Kaplan-Meier survival analysis for 1-year mortality shows that patients with RV systolic dysfunction (p=0.026) and RV dilatation (p=0.005) had an increased 1-year all-cause mortality. Patients presenting with both, RV systolic dysfunction and RV dilatation, exhibited a very high 1-year mortality of 71% (p&lt;0.001). Conclusion The assessment of RV volumes and function by CMR imaging yields important prognostic information that enable an estimation of heart failure severity and prognosis. In this regard, not only RV systolic dysfunction, but also RV dilatation was associated with increased 1-year mortality, while patients presenting with both exhibit additive high mortality risk. Therefore, current criteria for patient selection that are mainly based on mitral valve characteristics only, should also consider RV volumes and function as can be accurately assessed by CMR. Funding Acknowledgement Type of funding source: None

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