scholarly journals 292 Mechanical stress, myocardial deformation abnormalities, and ventricular fibrosis: a fatal cascade in arrhythmic mitral valve prolapse patients

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Annagrazia Cecere ◽  
Manuel De Lazzari ◽  
Alberto Cipriani ◽  
Giulia Brunetti ◽  
Francesca Graziano ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Valve Prolapse ◽  
Longitudinal Strain ◽  
Circumferential Strain ◽  
Left Ventricular ◽  
Myocardial Deformation ◽  
Control Group ◽  
Deformation Pattern ◽  
Basal Region ◽  
Post Contrast

Abstract Aims Arrhythmic mitral valve prolapse (MVP) is characterized by left ventricular (LV) fibrosis in the basal inferolateral wall and papillary muscles. We hypothesized that LV fibrosis are driven by excessive mechanical forces acting on myocardial susceptible cells, representing the last step in the MVP-induced myocardial stretch process. We evaluated the LV myocardial deformation, using strain assessed with cardiac magnetic resonance (CMR), in arrhythmic MVP patients with normal LV ejection fraction (LVEF) and absent/trivial mitral regurgitation (MR) and its correlation with the presence of LV fibrosis, detected by late gadolinium enhancement (LGE) in post-contrast CMR images. Methods and results We enrolled consecutive arrhythmic MVP patients with normal LVEF and no/trivial MR. Sixty-nine (39 female; median age: 40 years) patients without MVP, arrhythmias or cardiovascular history served as control group. All patients underwent CMR for identification of LGE and evaluation of LV myocardial deformation. A total of 66 patients were enrolled (47 female; median age: 44 years). In the overall MVP population, LGE was present in 41 patients (62.1%). MVP patients without LGE (25 patients, 37.9%) presented a higher global radial (median: 42.19 vs. 33; P <0.0001) and higher global longitudinal strain (median: −21.61 vs. −18.10; P <0.0001), compared to the control group. A reduction of regional basal posterolateral radial (BPL median: 50.60 vs. 67.30; P = 0.0015) and longitudinal strain (BPL median: −23.50 vs. −26.70; P = 0.0186) were observed in the MVP patients as compared with controls (Figures A–D). Conversely to the basal region, mid anterolateral and posterolateral region presented a higher radial (MAL median: 52.60 vs. 31.10; P < 0.0001 and MPL median: 52.80 vs. 21.50; P < 0.0001) and longitudinal strain (MAL median: −24.80 vs. −18.30; P < 0.0001 and MPL median: −25.30 vs. −14.80; P < 0.0001), when compared to control group. MVP patients with LGE had a lower global radial (median: 36.48 vs. 42.19; P <0.0047), longitudinal (median: −19.18 vs. −21.61; P = 0.0013), and circumferential strain (median: −17.80 vs. −19.28; P =  0.0134) compared with those without fibrosis. According to MVP patients without LGE, the presence of fibrosis is associated with a lower regional radial (BAL median: 64.40 vs. 82.80; P = 0.0481; MAL median: 42.60 vs. 52.60; P = 0.0287) and circumferential strain (BAL median: −21.90 vs. −24.20; P = 0.0174; BPL median: −16.80 vs. −18.80; P = 0.0411; MPL median: −15.50 vs. −19.40; P = 0.0077) in the LV basal-mid lateral walls (Figures E–H). 292 Figures A–D and E-H  Conclusions Arrhythmic MVP patients with normal LV systolic function and absent/trivial MR presented an abnormal myocardial deformation pattern. The reduced strain in BPL wall of MVP patients without LGE could be considered as an early marker of MVP-induced myocardial stress, that could promote, time by time, LV fibrosis and arrhythmias in MVP patients.

scholarly journals Left ventricular myocardial deformation abnormalities in arrhythmic mitral valve prolapse: which comes first?

2021 ◽  
Vol 22 (Supplement_2) ◽  
Author(s):  
A Cecere ◽  
M De Lazzari ◽  
A Cipriani ◽  
B Giorgi ◽  
R Motta ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Valve Prolapse ◽  
Longitudinal Strain ◽  
Circumferential Strain ◽  
Left Ventricular ◽  
Myocardial Deformation ◽  
Control Group ◽  
Deformation Pattern ◽  
Basal Region ◽  
Post Contrast

Abstract Funding Acknowledgements Type of funding sources: None. Background. Arrhythmic mitral valve prolapse (MVP) is characterized by left ventricular (LV) fibrosis in the basal inferolateral wall and papillary muscles. We hypothesized that LV fibrosis are driven by excessive mechanical forces acting on myocardial susceptible cells, representing the last step in the MVP-induced myocardial stretch process. Purpose. We aimed to evaluate the LV myocardial deformation, using strain assessed with cardiac magnetic resonance (CMR), in arrhythmic MVP patients with normal LV ejection fraction (LVEF) and absent/trivial mitral regurgitation (MR) and its correlation with the presence of LV fibrosis, detected by late gadolinium enhancement (LGE) in post-contrast CMR images. Methods. We enrolled consecutive arrhythmic MVP patients with normal LVEF and no/trivial MR. Sixty-nine (39 female; median age: 40 years) patients without MVP, arrhythmias or cardiovascular history served as control group. All patients underwent CMR for identification of LGE and evaluation of LV myocardial deformation. Results. A total of 66 patients were enrolled (47 female; median age: 44 years). In the overall MVP population, LGE was present in 41 patients (62.1%). MVP patients without LGE (25 patients, 37.9%) presented a higher global radial (median: 42.19 vs 33; p: <0.0001) and higher global longitudinal strain (median: -21.61 vs -18.10; p: <0.0001), compared to the control group. A reduction of regional basal posterolateral radial (BPL median: 50.60 vs 67.30; p: 0.0015) and longitudinal strain (BPL median: -23.50 vs -26.70; p: 0.0186) were observed in the MVP patients as compared with controls (Figures A-D). Conversely to the basal region, mid anterolateral and posterolateral region presented a higher radial (MAL median: 52.60 vs 31.10; p: < 0.0001 and MPL median: 52.80 vs 21.50; p: < 0.0001) and longitudinal strain (MAL median: -24.80 vs -18.30; p: < 0.0001 and MPL median: -25.30 vs -14.80; p: < 0.0001), when compared to control group. MVP patients with LGE had a lower global radial (median: 36.48 vs 42.19; p: <0.0047), longitudinal (median: -19.18 vs -21.61; p: 0.0013) and circumferential strain (median: -17.80 vs -19.28; p: 0.0134) compared with those without fibrosis. According to MVP patients without LGE, the presence of fibrosis is associated with a lower regional radial (BAL median: 64.40 vs 82.80; p: 0.0481; MAL median: 42.60 vs 52.60; p: 0.0287) and circumferential strain (BAL median: -21.90 vs -24.20; p: 0.0174; BPL median: -16.80 vs -18.80; p: 0.0411; MPL median: -15.50 vs -19.40; p: 0.0077) in the LV basal-mid lateral walls (Figures E-I). Conclusions. Arrhythmic MVP patients with normal LV systolic function and absent/trivial MR presented an abnormal myocardial deformation pattern. The reduced strain in BPL wall of MVP patients without LGE could be considered as an early marker of MVP-induced myocardial stress, that could promote, time by time, LV fibrosis and arrhythmias in MVP patients.

scholarly journals Layer-specific myocardial strain analysis: investigation of regional deformation in a rabbit model of diabetes mellitus during different stages.

2016 ◽  
Vol 18 (3) ◽  
pp. 339 ◽  
Author(s):  
Ying-Yan Qiao ◽  
Mu Zeng ◽  
Rong-Juan Li ◽  
Zhao-Ting Leng ◽  
Jiao Yang ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Longitudinal Strain ◽  
Circumferential Strain ◽  
Myocardial Dysfunction ◽  
Myocardial Strain ◽  
Myocardial Damage ◽  
Left Ventricular ◽  
Myocardial Deformation ◽  
Control Group ◽  
Significant Difference

Aim: The purpose of the present study was to determine the characteristics of myocardial damage at different stages of diabetes mellitus (DM) using layer-specific myocardial strain. Material and methods: Thirty six New Zealand white rabbits were randomly divided into either the control group (n =18) or the DM group (induced with alloxan) (n=18). For the myocardial deformation studies echocardiography and layer-specific strain were performed at baseline and after 3, 6, and 9 months in all of the rabbits. Three-layer longitudinal strain (LS) was calculated in the apical 4-chamber view, and three-layer circumferential strain (CS) in the short-axis view at the level of mitral valve. Layer-specific longitudinal and circumferential strains were assessed from endocardium, mid-myocardium and epicardium. For histomorphological study of the heart structure, the rabbits were sacrificed at 3, 6 and 9 months. Routine hematoxylin and eosin staining was performed. Results: The highest absolute values of left ventricular longitudinal strain (LS) and circumferential strain (CS) were registered in the endocardium and the lowest in the epicardium in both groups. At 3 months, there was no significant difference in three-layer LS and CS (p>0.05), but at 6 months the LS of endocardium (LSendo) and CS of endocardium (CSendo) were lower in the DM group compared with the control group; at 9 months, the rest of the parameters were also decreased (p<0.05). Moreover, in ROC analysis at 6 months LSendo yielded better sensitivity and specificity in the detection of diabetic cardiomyopathy (AUC of LSendo was 0.897 and AUC of CSendo was 0.617). With the progression of untreated diabetes, the histopathological abnormalities intensified gradually beginning at 6 months. Conclusion: The progressive impairments in LV myocardial deformation and structure occurs early in diabetic rabbits, the myocardial damage may be nontransmural, and endocardial function is more susceptible to be affected by DM. Layer-specific myocardial strain echocardiography may identify subtle myocardial dysfunction in the early stages of DM.

scholarly journals Left ventricular mechanical dispersion predicts arrhythmic risk in mitral valve prolapse

Heart ◽  
2019 ◽  
Vol 105 (14) ◽  
pp. 1063-1069 ◽  
Author(s):  
Simon Ermakov ◽  
Radhika Gulhar ◽  
Lisa Lim ◽  
Dwight Bibby ◽  
Qizhi Fang ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Ejection Fraction ◽  
Myocardial Fibrosis ◽  
Mitral Valve Prolapse ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Peak Strain ◽  
Mechanical Dispersion ◽  
Lv Ejection Fraction

ObjectiveBileaflet mitral valve prolapse (MVP) with either focal or diffuse myocardial fibrosis has been linked to ventricular arrhythmia and/or sudden cardiac arrest. Left ventricular (LV) mechanical dispersion by speckle-tracking echocardiography (STE) is a measure of heterogeneity of ventricular contraction previously associated with myocardial fibrosis. The aim of this study is to determine whether mechanical dispersion can identify MVP at higher arrhythmic risk.MethodsWe identified 32 consecutive arrhythmic MVPs (A-MVP) with a history of complex ventricular ectopy on Holter/event monitor (n=23) or defibrillator placement (n=9) along with 27 MVPs without arrhythmic complications (NA-MVP) and 39 controls. STE was performed to calculate global longitudinal strain (GLS) as the average peak longitudinal strain from an 18-segment LV model and mechanical dispersion as the SD of the time to peak strain of each segment.ResultsMVPs had significantly higher mechanical dispersion compared with controls (52 vs 42 ms, p=0.005) despite similar LV ejection fraction (62% vs 63%, p=0.42) and GLS (−19.7 vs −21, p=0.045). A-MVP and NA-MVP had similar demographics, LV ejection fraction and GLS (all p>0.05). A-MVP had more bileaflet prolapse (69% vs 44%, p=0.031) with a similar degree of mitral regurgitation (mostly trace or mild in both groups) (p>0.05). A-MVP exhibited greater mechanical dispersion when compared with NA-MVP (59 vs 43 ms, p=0.0002). Mechanical dispersion was the only significant predictor of arrhythmic risk on multivariate analysis (OR 1.1, 95% CI 1.02 to 1.11, p=0.006).ConclusionsSTE-derived mechanical dispersion may help identify MVP patients at higher arrhythmic risk.

Reference values for two-dimensional myocardial strain echocardiography of the left ventricle in healthy children

2019 ◽  
Vol 29 (3) ◽  
pp. 325-337
Author(s):  
Laurens P. Koopman ◽  
Bas Rebel ◽  
Devi Gnanam ◽  
Mirthe E. Menting ◽  
Willem A. Helbing ◽  
...  
Keyword(s):  
Left Ventricle ◽  
Strain Rate ◽  
Longitudinal Strain ◽  
Circumferential Strain ◽  
Left Ventricular ◽  
Myocardial Deformation ◽  
Healthy Children ◽  
Deformation Parameters ◽  
Strain And Strain Rate ◽  
Echocardiographic Parameters

AbstractBackgroundMyocardial deformation by speckle tracking echocardiography provides additional information on left ventricular function. Values of myocardial deformation (strain and strain rate) depend on the type of ultrasound machine and software that is used. Normative values for QLAB (Philips) are scarce, especially for children. It is important to evaluate the influence of age and body size on myocardial deformation parameters, since anthropometrics strongly influence many standard echocardiographic parameters. The aim of this study was to provide comprehensive normal values for myocardial deformation of the left ventricle using a Philips platform and to evaluate the association with anthropometric and standard echocardiographic parameters.MethodsHealthy children between 1 and 18 years of age were prospectively examined using a standard echocardiographic protocol. Short-axis and apical four-chamber, two-chamber, and three-chamber views were used to measure peak systolic circumferential and longitudinal strain and systolic and early diastolic strain rate of the left ventricle using dedicated software.ResultsA total of 103 children were included with a mean age of 10.8 and inter-quartile range 7.3–14.3 years. Global circumferential strain values (±SD) were −24.2±3.5% at basal, −25.8±3.5% at papillary muscle, and −31.9±6.2% at apex levels. Global left ventricular longitudinal strain values were −20.6±2.6% in apical four-chamber view, −20.9±2.7% in apical two-chamber, and −21.0 ±2.7% in apical three-chamber. Age was associated with longitudinal strain, longitudinal systolic and early diastolic strain rate, but not with circumferential strain.ConclusionsNormal values for left ventricular deformation parameters in children are obtained using a Philips platform. Age partly explains normal variation of strain and strain rate.

scholarly journals Cardiomyopathy in young adults with classic mitral valve prolapse

2013 ◽  
Vol 24 (4) ◽  
pp. 694-701 ◽  
Author(s):  
Eduard Malev ◽  
Svetlana Reeva ◽  
Lyubov Vasina ◽  
Eugeny Timofeev ◽  
Asiyet Pshepiy ◽  
...  
Keyword(s):  
Young Adults ◽  
Growth Factor ◽  
Mitral Valve ◽  
Left Ventricular Function ◽  
Ventricular Function ◽  
Mitral Valve Prolapse ◽  
Transforming Growth Factor ◽  
Transforming Growth Factor Β ◽  
Left Ventricular ◽  
Control Group

AbstractBackground: In some inherited connective tissue diseases with involvement of the cardiovascular system, for example, Marfan syndrome, early impairment of left ventricular function, which have been described as Marfan-related cardiomyopathy has been reported. Our aim was to evaluate the left ventricular function in young adults with mitral valve prolapse without significant mitral regurgitation using two-dimensional strain imaging and to determine the possible role of the transforming growth factor-β pathway in its deterioration. Methods: We studied 78 young adults with mitral valve prolapse without mitral regurgitation in comparison with 80 sex-matched and age-matched healthy individuals. Longitudinal strain and strain rates were defined using spackle tracking. Concentrations of transforming growth factor-β1 and β2 in serum were determined by enzyme-linked immunosorbent assays. Results: In 29 patients, classic relapse was identified with a leaflet thickness of ≥ 5 mm; 49 patients had a non-classic mitral valve prolapse. Despite the similar global systolic function, a significant reduction in global strain was found in the classic group (−15.5 ± 2.9%) compared with the non-classic group (−18.7 ± 3.8; p = 0.0002) and the control group (−19.6 ± 3.4%; p < 0.0001). In young adults with non-classic prolapse, a reduction in longitudinal deformation was detected only in septal segments. Transforming growth factor-β1 and β2 serum levels were elevated in patients with classic prolapse as compared with the control group and the non-classic mitral valve prolapse group. Conclusions: These changes in the deformations may be the first signs of deterioration of the left ventricular function and the existence of primary cardiomyopathy in young adults with mitral valve prolapse, which may be caused by increased transforming growth factor-β signalling.

scholarly journals Echocardiographic Assessment of the Left Ventricular Physical Parameters: A Comparison Study in Patients With Significant and Non-Significant Coronary Artery Disease

2020 ◽  
Author(s):  
Zeinab Alsadat Ahmadi ◽  
Manijhe Mokhtari-Dizaji ◽  
Anita Sadeghpour ◽  
Hamideh Khesali ◽  
Ata Firouzi
Keyword(s):  
Coronary Artery Disease ◽  
Elastic Modulus ◽  
Coronary Artery ◽  
Longitudinal Strain ◽  
Circumferential Strain ◽  
Left Ventricular ◽  
Control Group ◽  
Physical Parameters ◽  
Ellipsoidal Model ◽  
Artery Disease

Abstract BackgroundIn this study, physical parameters of the strain of left ventricle (LV), wall stress with a thick-walled ellipsoidal model, and elastic modulus of LV were extracted for distinguishing patients who were stent candidates.Materials and MethodsEighty-eight patients with suspected coronary artery disease (CAD) underwent echocardiography and angiography. Based on angiography results, the patients were divided into two groups (64 patients candidate for PCI (percutaneous coronary intervention) and 24 cases in the control group). Long-axis and short-axis echocardiographic views were acquired. Radial, longitudinal, and circumferential stress were estimated by the thick-walled ellipsoidal model. Circumferential strain (CS) and longitudinal strain (Ls) were obtained for 18 segments in the endocardium layer of LV, and then GLS (global longitudinal strain) and GCS (global circumferential strain) were calculated.ResultAnterior and inferoseptal circumferential wall stresses in end-systole (ES) were statistically significant (P<0.05), but radial and longitudinal stress were not significant (P>0.05). Peak systolic GCS and GLS were lower in the PCI group (-18.13±3.03 and -16.57±2.88%) compared to the control group (-21.97±3.97 and 19.14±2.17%), respectively (p<0.05). The receiver operator characteristic curve (ROC) analysis revealed that GLS and GCS had the highest area under the ROC curve with a sensitivity of 83% and specificity of 63% for GLS and sensitivity of 71% and specificity of 59% for GCS.ConclusionStress and strain parameters are suggested as non-invasive and quantitative tools for measuring left ventricular function before angiography. Regional elastic modulus was a powerful predictor that can be distinguishing significant CAD patients.

Abstract 15528: Myocardial Deformation Imaging and Obstruction in Hypertrophic Cardiomyopathy, Insights from Cross-sectional and Post-myectomy Analysis

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Yukari Kobayashi ◽  
Gherardo Finocchiaro ◽  
Genevieve Giraldeau ◽  
David Boulate ◽  
Yuhei Kobayashi ◽  
...  
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
Longitudinal Strain ◽  
Circumferential Strain ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Myocardial Deformation ◽  
Cross Sectional ◽  
Alcohol Ablation ◽  
Left Ventricular Deformation ◽  
The Impact

Background: Hypertrophic cardiomyopathy (HCM) has been reported to alter left ventricular deformation. However, little is known about the differences of left ventricular (LV) strain values among healthy and varying levels of HCM patients including non-obstructive and obstructive, nor about the impact of septal reduction therapy on strain values. Methods: Age- and sex matched patients with HCM and varying degree of obstruction as well as 48 healthy controls were studied. Among HCM patients, 28 subjects had non-obstructive HCM, 27 had mildly symptomatic obstructive HCM, and 34 had HCM requiring septal reduction therapy (either myectomy or alcohol ablation). LV global longitudinal strain (LV-GLS) and circumferential strain as well as routine echocardiography were evaluated. Detailed LV longitudinal strain was assessed with septal and lateral longitudinal strain (Sept.-LS and Lat.-LS). In HCM patients treated with septal reduction, echocardiography was performed before, 3-months, and 1-year after the procedure. Results: LV-GLS, Sept.-LS, and Lat.-LS of all HCM patients were significantly lower than controls (p<0.001, p<0.001, p<0.05, respectively), and circumferential endocardial and mid strain were higher (p<0.05). Significant differences among controls and varying levels of HCM subgroups were detected only in Sept.-LS, which enabled to stratify the HCM severity (left panel in Figure). In addition, Sept.-LS has the strongest correlation with the average LV wall thickness (right panel in Figure). Furthermore, Sept.-LS was significantly improved after septal reduction, whereas Lat.-LS and circumferential strain did not change. Conclusions: The strongest relationship between myocardial deformation and obstruction in HCM was found for Sept.-LS. Also, septal reduction procedure preferentially improves Sept.-LS.

scholarly journals 0117: Left ventricular mechanics in mitral valve prolapse: a longitudinal strain study

2016 ◽  
Vol 8 (1) ◽  
pp. 47
Author(s):  
Maxime Poilane ◽  
Caroline Cueff ◽  
Philippe Jaafar ◽  
Antoine Jobbe Duval ◽  
Nicolas Piriou ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Valve Prolapse ◽  
Longitudinal Strain ◽  
Left Ventricular ◽  
Ventricular Mechanics ◽  
Left Ventricular Mechanics

scholarly journals Myocardial extracellular volume by T1 mapping: a new marker of arrhythmia in mitral valve prolapse

2021 ◽  
Vol 22 (Supplement_2) ◽  
Author(s):  
A Pavon ◽  
D Arangalage ◽  
S Hugelshofer ◽  
T Rutz ◽  
AP Porretta ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Valve Prolapse ◽  
Interstitial Fibrosis ◽  
Extracellular Volume ◽  
Holter Monitoring ◽  
Left Ventricular ◽  
Control Group ◽  
Funding Sources ◽  
Replacement Fibrosis ◽  
Additional Value

Abstract Funding Acknowledgements Type of funding sources: None. Background In MVP, MAD has been associated with myocardial replacement fibrosis and arrhythmia, but the importance of interstitial fibrosis remains unknown. We aimed to evaluate the relationship between mitral annular disjunction (MAD) severity and myocardial interstitial fibrosis at the left ventricular (LV) base in patients with mitral valve prolapse (MVP), and to assess the association between severity of interstitial fibrosis and the occurrence of ventricular arrhythmic events Methods Thirty patients with MVP and MAD (MVP-MAD) underwent Cardiac Magnetic Resonance (CMR) with assessment of MAD length, late gadolinium enhancement (LGE), and basal segments myocardial extracellular volume (ECV). The control group included 14 patients with mitral regurgitation but no MAD (MR-NoMAD) and 10 patients with normal CMR (NoMR-NoMAD). Fifteen MVP-MAD patients underwent 24h-Holter monitoring. Results LGE was observed in 47% of MVP-MAD patients and absent in controls. ECV was higher in MVP-MAD (30 ± 3% vs 24 ± 3% MR-NoMAD, p &lt; 0.0001 and vs 24 ± 2% NoMR-NoMAD, p &lt; 0.0001), even in MVP-MAD patients without LGE (29 ± 3% vs 24 ± 3%, p &lt; 0.0001 and vs 24 ± 2%, p &lt; 0.0001, respectively), Fig.1. MAD length was correlated with ECV (rho = 0.61, p = 0.0003), but not with LGE extent. Four patients had history of OHCA; LGE and ECV were equally performant to identify those high-risk patients (area under the ROC curve 0.81 vs 0.83, p = 0.84). Among patients with Holter, 87% had complex ventricular arrhythmia. ECV was above the cut-off value in all while only 53% had LGE. Conclusion Increase in ECV, a marker of interstitial fibrosis, occurs in MVP-MAD even in the absence of LGE, and was correlated with MAD length and OHCA. ECV should be part of the CMR examination of MVP patients in an effort to better assess fibrous remodelling as it may provide additional value beyond the assessment of LGE in the arrhythmic risk stratification.

scholarly journals 1047 Increased interstitial fibrosis in patients with mitral valve prolapse and mitro-annular dysjunction

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
A Pavon ◽  
S Hugelshofer ◽  
T Rutz ◽  
P Pascale ◽  
E Pruvot ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Papillary Muscle ◽  
Mitral Valve Prolapse ◽  
Interstitial Fibrosis ◽  
Extracellular Volume ◽  
Ventricular Myocardium ◽  
Left Ventricular ◽  
Control Group ◽  
Left Ventricular Myocardium ◽  
Inferior Wall

Abstract Background in patients with myxomatous mitral valve prolapse (MVP), mitral annular disjunction (MAD) has been associated with the presence of late gadolinium enhancement (LGE) at papillary muscle level and the risk of sudden cardiac death. However, patients with MAD but no detectable LGE still may have arrhythmia. We investigated the relation between MAD and the presence of interstitial fibrosis in the basal inferior left ventricular myocardium. Methods 28 patient with MVP and associated MAD underwent Cardiovascular Magnetic Resonance imaging (CMR) at 1.5 T scanner (Aera, Siemens Medical Solutions, Erlangen, Germany). Exclusion criteria were ischemic heart disease, infiltrative cardiomyopathy and contraindication to CMR. 12 patients with mitral valve regurgitation but no MAD and 10 patients without mitral disease served as the control group. MAD severity was measured from LA wall-posterior MV leaflet junction to the top of the LV infero-basal wall during end systole. Insterstitial fibrosis was assessed by calculating the extracellular volume (ECV) from T1 mapping of the left ventricular basal slice acquired before and after Gadolinium injection. Results Mean age was 47,5+\-23,3 years and 60% were male. ECV was higher in patients with MVP compared with controls (basal septum: 0.27 ± 0.04 vs 0.23 ± 0.03 p = 0.006; basal inferoposterior wall 0.28 ± 0.03 vs 0.23 ± 0.02 p = 0.003) and there was a significant correlation between MAD severity and ECV of the basal inferior wall (spearman rho 0.68, p &lt; 0.0001) (Figure 1). Among MVP patients, ECV of the basal inferoposterior wall was higher in patients positive for LGE in the papillary muscles (ECV 0.31 ± 0.03 vs 0.27 ± 0.03 p 0,004). Conclusion In MVP patients, MAD severity was associated with a higher amount of interstitial fibrosis even in the absence of detectable macroscopic fibrosis in the papillary muscle region. Abstract 1047 Figure 1

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