Abnormal Mechanics Relate to Myocardial Fibrosis and Ventricular Arrhythmias in Patients With Mitral Valve Prolapse
Year: 2023
Type: article
Study design: Observational Study
Abstract: BACKGROUND: The relation between ventricular arrhythmia and fibrosis in mitral valve prolapse (MVP) is reported, but underlying valve-induced mechanisms remain unknown. We evaluated the association between abnormal MVP-related mechanics and myocardial fibrosis, and their association with arrhythmia. METHODS: We studied 113 patients with MVP with both echocardiogram and gadolinium cardiac magnetic resonance imaging for myocardial fibrosis. Two-dimensional and speckle-tracking echocardiography evaluated mitral regurgitation, superior leaflet and papillary muscle displacement with associated exaggerated basal myocardial systolic curling, and myocardial longitudinal strain. Follow-up assessed arrhythmic events (nonsustained or sustained ventricular tachycardia or ventricular fibrillation). RESULTS: <0.001) but absent in patients without MVP with basal inferior-lateral wall fibrosis (n=20). During median follow-up of 1008 days, 36 of 87 patients with MVP with >6-month follow-up developed ventricular arrhythmias associated (univariable) with fibrosis, greater prolapse, mitral annular disjunction, and double-peak strain. In multivariable analysis, double-peak strain showed incremental risk of arrhythmia over fibrosis. CONCLUSIONS: Basal inferior-posterior myocardial fibrosis in MVP is associated with abnormal MVP-related myocardial mechanics, which are potentially associated with ventricular arrhythmia. These associations suggest pathophysiological links between MVP-related mechanical abnormalities and myocardial fibrosis, which also may relate to ventricular arrhythmia and offer potential imaging markers of increased arrhythmic risk.
Authors: Yasufumi Nagata, Philippe B. Bertrand, Vinit Baliyan, Jonathan Kochav, Ruth D. Kagan, Kristian Ujka, Hassan Alfraidi, Antonia van Kampen, Jordan E. Morningstar, Jacob P. Dal-Bianco, Serguei Melnitchouk, Godtfred Holmvang, Michael A. Borger, Reece Moore, Lanqi Hua, Razia Sultana, Pablo Villar Calle, Brian Yum, J. Luis Guerrero, Tomas G. Neilan, Michael H. Picard, Jiwon Kim, Francesca N. Delling, Judy Hung, Russell A. Norris, Jonathan W. Weinsaft, Robert A. Levine
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Awards: G350062807, Bioengineering Center for Regeneration and Formation of Tissues (SC BioCRAFT), CMR Myocardial Tissue Based Prediction of Ischemic MR Revascularization Response, EXTRAMURAL RESEARCH FACILITIES CONSTRUCTION, Improving Mitral Compensation In Ischemic Regurgitation, Bioengineering Center of Regeneration and Formation of Tissues (SC BioCRAFT), Dzip1 and Mitral Valve Prolapse, 3D Echocardiography to Improve Clinical Outcomes After Surgery for Ischemic Mitral Regurgitation, Mechanisms of Left Ventricular Fibrosis in Mitral Valve Prolapse, Prospective sudden cardiac death risk stratification using CMR and echocardiography machine learning in mitral valve prolapse, Advanced CMR Tissue-Based Prediction of Right Ventricular Dysfunction and Revascularization Response, Mechanisms of DMP Development and Atrioventricular Septation, Role of the Epicardium in Valve Development and Valve Disease, Cilia and Valvular Heart Disease, Cardiovascular Diseases among Patients with Cancer and Patients living with HIV
OpenAlex ID: W4366336928