Left ventricular fibrosis and CMR tissue characterization of papillary muscles in mitral valve prolapse patients
Year: 2023
Type: article
Study design: Observational Study
Abstract: Purpose. Mitral valve prolapse (MVP) is associated with left ventricle (LV) fibrosis, including the papillary muscles (PM), which is in turn linked to malignant arrhythmias. This study aims to evaluate comprehensive tissue characterization of the PM by cardiovascular magnetic resonance (CMR) imaging and its association with LV fibrosis observed by intraoperative biopsies. Methods. MVP patients with indication for surgery due to severe mitral regurgitation (n=19) underwent a preoperative CMR with characterization of the PM: dark-appearance on cine, T1 mapping, conventional bright blood (BB) and dark blood (DB) late gadolinium enhancement (LGE). CMR T1 mapping was performed on 21 healthy volunteers as controls. LV inferobasal myocardial biopsies were obtained in MVP patients and compared to CMR findings. Results. MVP patients (54±10 years old, 14 male) had a dark-appearance of the PM with higher native T1 and extracellular volume (ECV) values compared with healthy volunteers (1096±78ms vs 994±54ms and 33.9±5.6% vs 25.9±3.1%, respectively, p<0.001). Seventeen MVP patients (89.5%) had fibrosis by biopsy. BB-LGE+ in LV and PM was identified in 5 (26.3%) patients, while DB-LGE+ was observed in LV in 9 (47.4%) and in PM in 15 (78.9%) patients. DB-LGE+ in PM was the only technique that showed no difference with detection of LV fibrosis by biopsy. Posteromedial PM was more frequently affected than the anterolateral (73.7% vs 36.8%, p=0.039) and correlated with biopsy-proven LV fibrosis (Rho 0.529, p=0.029). Conclusions. CMR imaging in MVP patients referred for surgery shows a dark-appearance of the PM with higher T1 and ECV values compared with healthy volunteers. The presence of a positive DB-LGE at the posteromedial PM by CMR may serve as a better predictor of biopsy-proven LV inferobasal fibrosis than conventional CMR techniques.
Authors: Ricardo A. Spampinato, Mateo Marin-Cuartas, Antonia van Kampen, Florian Fahr, Franz Sieg, Elfriede Strotdrees, Cosima Jahnke, Kristin Klaeske, Karoline Wiesner, Jordan E. Morningstar, Yasufumi Nagata, David Izquierdo-Garcia, Maja-Theresa Dieterlen, Russell A. Norris, Robert A. Levine, Ingo Paetsch, Michael A. Borger
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: green
Awards: Mechanisms of DMP Development and Atrioventricular Septation, Improving Mitral Compensation In Ischemic Regurgitation, Bioengineering Center of Regeneration and Formation of Tissues (SC BioCRAFT), Dzip1 and Mitral Valve Prolapse, Dzip1 and Mitral Valve Prolapse, Mechanisms of DMP Development and Atrioventricular Septation, Role of the Epicardium in Valve Development and Valve Disease, Mechanism of Myocardial Fibrosis Induced by Mitral Valve Prolapse, Cilia and Valvular Heart Disease
OpenAlex ID: W4387996553