Diffuse myocardial fibrosis in patients with mitral valve prolapse and ventricular arrhythmia

• Published in: Heart (British Cardiac Society) Vol. 103; no. 3; pp. 204 - 209
• Main Authors: Bui, An H, Roujol, Sébastien, Foppa, Murilo, Kissinger, Kraig V, Goddu, Beth, Hauser, Thomas H, Zimetbaum, Peter J, Ngo, Long H, Manning, Warren J, Nezafat, Reza, Delling, Francesca N
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01.02.2017
• Subjects: Adult; Arrhythmias, Cardiac - diagnostic imaging; Arrhythmias, Cardiac - etiology; Arrhythmias, Cardiac - pathology; Arrhythmias, Cardiac - physiopathology; Boston; Cardiac arrhythmia; Cardiomyopathies - diagnostic imaging; Cardiomyopathies - etiology; Cardiomyopathies - pathology; Cardiomyopathies - physiopathology; Cardiomyopathy; Cardiovascular disease; Contrast Media - administration & dosage; Databases, Factual; Female; Fibrosis; Humans; Magnetic Resonance Imaging, Cine; Male; Middle Aged; Mitral valve prolapse; Mitral Valve Prolapse - complications; Mitral Valve Prolapse - diagnostic imaging; Mitral Valve Prolapse - pathology; Mitral Valve Prolapse - physiopathology; Myocardium - pathology; Predictive Value of Tests; Pulmonary arteries; Retrospective Studies; Stroke Volume; Ventricular Function, Left; Netherlands
• ISSN: 1355-6037; 1468-201X; 1468-201X
• DOI: 10.1136/heartjnl-2016-309303

ObjectiveWe aimed to investigate the association of diffuse myocardial fibrosis by cardiac magnetic resonance (CMR) T1 with complex ventricular arrhythmia (ComVA) in mitral valve prolapse (MVP).MethodsA retrospective analysis was performed on 41 consecutive patients with MVP referred for CMR between 2006 and 2011, and 31 healthy controls. Arrhythmia analysis was available in 23 patients with MVP with Holter/event monitors. Left ventricular (LV) septal T1 times were derived from Look-Locker sequences after administration of 0.2 mmol/kg gadopentetate dimeglumine. Late gadolinium enhancement (LGE) CMR images were available for all subjects.ResultsPatients with MVP had significantly shorter postcontrast T1 times when compared with controls (334±52 vs 363±58 ms; p=0.03) despite similar LV ejection fraction (LVEF) (63±7 vs 60±6%, p=0.10). In a multivariable analysis, LV end-diastolic volume, LVEF and mitral regurgitation fraction were all correlates of T1 times, with LVEF and LV end-diastolic volume being the strongest (p=0.005, p=0.008 and p=0.045, respectively; model adjusted R2=0.30). Patients with MVP with ComVA had significantly shorter postcontrast T1 times when compared with patients with MVP without ComVA (324 (296, 348) vs 354 (327, 376) ms; p=0.03) and only 5/14 (36%) had evidence of papillary muscle LGE.ConclusionsMVP may be associated with diffuse LV myocardial fibrosis as suggested by reduced postcontrast T1 times. Diffuse interstitial derangement is linked to subclinical systolic dysfunction, and may contribute to ComVA in MVP-related mitral regurgitation, even in the absence of focal fibrosis.