Danai Kitkungvan1, Faisal Nabi2, Raymond J Kim3, Robert O Bonow4, Mohammad A Khan2, Jiaqiong Xu2, Stephen H Little2, Miguel A Quinones2, Gerald M Lawrie2, William A Zoghbi2, Dipan J Shah5. 1. Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas; Division of Cardiovascular Medicine, McGovern Medical School, University of Texas Health and Science Center at Houston, Houston, Texas. 2. Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas. 3. Duke Cardiovascular Magnetic Resonance Center, Departments of Medicine and Radiology, Duke University Medical Center, Durham, North Carolina. 4. Division of Cardiology, Northwestern Memorial Hospital and Northwestern University Feinberg School of Medicine, Chicago, Illinois. 5. Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas. Electronic address: djshah@houstonmethodist.org.
Abstract
BACKGROUND: Recent studies reported left ventricular (LV) fibrosis in patients with primary mitral regurgitation (MR) thought to be principally due to mitral valve prolapse (MVP). OBJECTIVES: This study sought to evaluate the prevalence, characteristics, and prognostic implications of LV fibrosis in a large cohort of primary MR patients with and without MVP using cardiovascular magnetic resonance (CMR). METHODS: Patients referred for contrast CMR assessment of chronic primary MR were enrolled and underwent comprehensive assessment of cardiac remodeling, severity of MR, and LV replacement fibrosis. Primary MR patients were stratified into: an MVP group if there was >2 mm mitral leaflet displacement on cine-CMR, or a non-MVP group. Patients were followed for arrhythmic events (sudden cardiac death, aborted sudden cardiac arrest, and sustained or inducible ventricular arrhythmia). RESULTS: A total of 356 primary MR patients (177 MVP and 179 non-MVP) were enrolled. LV fibrosis was more prevalent in the MVP group than the non-MVP group (36.7% vs. 6.7%; p < 0.001). The presence of MVP had the strongest association (odds ratio: 6.82; p < 0.001) with LV fibrosis even after adjustment for clinical variables, measures of cardiac remodeling, and MR severity. During follow-up (median 1,354 days), MVP patients with LV fibrosis had the highest event rate for arrhythmic events. CONCLUSIONS: In primary MR patients, LV fibrosis is more prevalent in MVP than non-MVP, suggesting a unique pathophysiology beyond volume overload in MVP. LV fibrosis in primary MR may represent a risk marker of arrhythmic events.
BACKGROUND: Recent studies reported left ventricular (LV) fibrosis in patients with primary mitral regurgitation (MR) thought to be principally due to mitral valve prolapse (MVP). OBJECTIVES: This study sought to evaluate the prevalence, characteristics, and prognostic implications of LV fibrosis in a large cohort of primary MRpatients with and without MVP using cardiovascular magnetic resonance (CMR). METHODS:Patients referred for contrast CMR assessment of chronic primary MR were enrolled and underwent comprehensive assessment of cardiac remodeling, severity of MR, and LV replacement fibrosis. Primary MRpatients were stratified into: an MVP group if there was >2 mm mitral leaflet displacement on cine-CMR, or a non-MVP group. Patients were followed for arrhythmic events (sudden cardiac death, aborted sudden cardiac arrest, and sustained or inducible ventricular arrhythmia). RESULTS: A total of 356 primary MRpatients (177 MVP and 179 non-MVP) were enrolled. LV fibrosis was more prevalent in the MVP group than the non-MVP group (36.7% vs. 6.7%; p < 0.001). The presence of MVP had the strongest association (odds ratio: 6.82; p < 0.001) with LV fibrosis even after adjustment for clinical variables, measures of cardiac remodeling, and MR severity. During follow-up (median 1,354 days), MVP patients with LV fibrosis had the highest event rate for arrhythmic events. CONCLUSIONS: In primary MRpatients, LV fibrosis is more prevalent in MVP than non-MVP, suggesting a unique pathophysiology beyond volume overload in MVP. LV fibrosis in primary MR may represent a risk marker of arrhythmic events.
Authors: Marco Gatti; Anna Palmisano; Antonio Esposito; Stefano Fiore; Caterina Beatrice Monti; Alessandro Andreis; Lorenzo Pistelli; Pasquale Vergara; Laura Bergamasco; Carla Giustetto; Francesco De Cobelli; Paolo Fonio; Riccardo Faletti Journal: Eur Radiol Date: 2021-04-19 Impact factor: 5.315
Authors: Katelynn A Toomer; Mengyao Yu; Diana Fulmer; Lilong Guo; Kelsey S Moore; Reece Moore; Ka'la D Drayton; Janiece Glover; Neal Peterson; Sandra Ramos-Ortiz; Alex Drohan; Breiona J Catching; Rebecca Stairley; Andy Wessels; Joshua H Lipschutz; Francesca N Delling; Xavier Jeunemaitre; Christian Dina; Ryan L Collins; Harrison Brand; Michael E Talkowski; Federica Del Monte; Rupak Mukherjee; Alexander Awgulewitsch; Simon Body; Gary Hardiman; E Starr Hazard; Willian A da Silveira; Baolin Wang; Maire Leyne; Ronen Durst; Roger R Markwald; Solena Le Scouarnec; Albert Hagege; Thierry Le Tourneau; Peter Kohl; Eva A Rog-Zielinska; Patrick T Ellinor; Robert A Levine; David J Milan; Jean-Jacques Schott; Nabila Bouatia-Naji; Susan A Slaugenhaupt; Russell A Norris Journal: Sci Transl Med Date: 2019-05-22 Impact factor: 17.956
Authors: Danai Kitkungvan; Eric Y Yang; Kinan C El Tallawi; Sherif F Nagueh; Faisal Nabi; Mohammad A Khan; Duc T Nguyen; Edward A Graviss; Gerald M Lawrie; William A Zoghbi; Robert O Bonow; Miguel A Quinones; Dipan J Shah Journal: Circulation Date: 2019-12-16 Impact factor: 29.690
Authors: Marc A Miller; David H Adams; Dimosthenis Pandis; Philip M Robson; Amit Pawale; Renata Pyzik; Steve L Liao; Ahmed El-Eshmawi; Percy Boateng; Jalaj Garg; Stephen Waterford; Menachem M Weiner; Srinivas R Dukkipati; Vivek Y Reddy; Zahi A Fayad; Maria G Trivieri Journal: JAMA Cardiol Date: 2020-05-27 Impact factor: 14.676
Authors: Marc A Miller; David H Adams; Dimosthenis Pandis; Philip M Robson; Amit Pawale; Renata Pyzik; Steve L Liao; Ahmed El-Eshmawi; Percy Boateng; Jalaj Garg; Stephen Waterford; Menachem M Weiner; Srinivas R Dukkipati; Vivek Y Reddy; Zahi A Fayad; Maria G Trivieri Journal: JAMA Cardiol Date: 2020-09-01 Impact factor: 14.676
Authors: Benjamin Fidock; Natasha Barker; Nithin Balasubramanian; Gareth Archer; Graham Fent; Abdullah Al-Mohammad; James Richardson; Laurence O'Toole; Norman Briffa; Alexander Rothman; Rob van der Geest; Rod Hose; James M Wild; Andrew J Swift; Pankaj Garg Journal: Front Cardiovasc Med Date: 2019-08-02