Importance: Myocardial replacement fibrosis has been reported to occur in one-third of patients with mitral valve prolapse (MVP) and significant mitral regurgitation (MR). However, it remains unknown whether there are detectable changes in myocardial metabolism suggestive of inflammation or ischemia that accompany the development of fibrosis. Objectives: To characterize the burden and distribution of fluorine 18-labeled (18F) fluorodeoxyglucose (FDG) uptake and late gadolinium enhancement (LGE) in patients with degenerative MVP and ventricular ectopy. Design, Setting, and Participants: Prospective observational study of 20 patients with MVP and significant primary degenerative MR who were referred for mitral valve repair and underwent hybrid positron emission tomography/magnetic resonance imaging (PET/MRI). Ventricular arrhythmias were categorized as either complex (n = 12) or minor (n = 8). Coregistered hybrid 18F FDG-PET and MRI LGE images were assessed and categorized. Recruitment occurred in the new patient clinic of a mitral valve repair reference center. This study was conducted from January 11, 2018, to June 26, 2019. Exposures: Simultaneous cardiac 18F FDG-PET and MRI with LGE imaging on a hybrid PET/MRI system and ambulatory rhythm monitoring. Main Outcomes and Measures: Patients were categorized by the presence and pattern of FDG uptake and LGE, the severity of ventricular arrhythmias, and the indication for mitral valve surgery. Results: In the cohort of 20 patients, the median age was 59.5 years (interquartile range, 52.5-63.2 years). Focal, or focal-on-diffuse uptake, of 18F-FDG (PET positive) was detected in 17 of 20 patients (85%). The FDG uptake coexisted with areas of LGE (PET/MRI positive) in 14 patients (70%). Of the 5 asymptomatic patients with normal ventricular indices and absence of any surgical indications, all were PET/MRI positive. Conclusions and Relevance: In this pilot study, we demonstrate a novel association between degenerative MVP and FDG uptake, a surrogate for myocardial inflammation and/or ischemia. Such evidence of myocardial injury, even in asymptomatic patients, suggests an ongoing subclinical disease process. These findings warrant further investigation into whether imaging for myocardial inflammation, ischemia, and scar has a role in arrhythmic risk stratification and whether it provides incremental prognostic value in patients with chronic severe mitral regurgitation undergoing active surveillance.
Importance: Myocardial replacement fibrosis has been reported to occur in one-third of patients with mitral valve prolapse (MVP) and significant mitral regurgitation (MR). However, it remains unknown whether there are detectable changes in myocardial metabolism suggestive of inflammation or ischemia that accompany the development of fibrosis. Objectives: To characterize the burden and distribution of fluorine 18-labeled (18F) fluorodeoxyglucose (FDG) uptake and late gadolinium enhancement (LGE) in patients with degenerative MVP and ventricular ectopy. Design, Setting, and Participants: Prospective observational study of 20 patients with MVP and significant primary degenerative MR who were referred for mitral valve repair and underwent hybrid positron emission tomography/magnetic resonance imaging (PET/MRI). Ventricular arrhythmias were categorized as either complex (n = 12) or minor (n = 8). Coregistered hybrid 18F FDG-PET and MRI LGE images were assessed and categorized. Recruitment occurred in the new patient clinic of a mitral valve repair reference center. This study was conducted from January 11, 2018, to June 26, 2019. Exposures: Simultaneous cardiac 18F FDG-PET and MRI with LGE imaging on a hybrid PET/MRI system and ambulatory rhythm monitoring. Main Outcomes and Measures: Patients were categorized by the presence and pattern of FDG uptake and LGE, the severity of ventricular arrhythmias, and the indication for mitral valve surgery. Results: In the cohort of 20 patients, the median age was 59.5 years (interquartile range, 52.5-63.2 years). Focal, or focal-on-diffuse uptake, of 18F-FDG (PET positive) was detected in 17 of 20 patients (85%). The FDG uptake coexisted with areas of LGE (PET/MRI positive) in 14 patients (70%). Of the 5 asymptomatic patients with normal ventricular indices and absence of any surgical indications, all were PET/MRI positive. Conclusions and Relevance: In this pilot study, we demonstrate a novel association between degenerative MVP and FDG uptake, a surrogate for myocardial inflammation and/or ischemia. Such evidence of myocardial injury, even in asymptomatic patients, suggests an ongoing subclinical disease process. These findings warrant further investigation into whether imaging for myocardial inflammation, ischemia, and scar has a role in arrhythmic risk stratification and whether it provides incremental prognostic value in patients with chronic severe mitral regurgitation undergoing active surveillance.
Authors: William A Zoghbi; David Adams; Robert O Bonow; Maurice Enriquez-Sarano; Elyse Foster; Paul A Grayburn; Rebecca T Hahn; Yuchi Han; Judy Hung; Roberto M Lang; Stephen H Little; Dipan J Shah; Stanton Shernan; Paaladinesh Thavendiranathan; James D Thomas; Neil J Weissman Journal: J Am Soc Echocardiogr Date: 2017-03-14 Impact factor: 5.251
Authors: Jérôme Hourdain; Marie Annick Clavel; Jean-Claude Deharo; Samuel Asirvatham; Jean François Avierinos; Gilbert Habib; Frederic Franceschi; Vincent Probst; Nicolas Sadoul; Raphael Martins; Christophe Leclercq; Michel Chauvin; Jean Luc Pasquie; Philippe Maury; Gabriel Laurent; Michael Ackerman; David O Hodge; Maurice Enriquez-Sarano Journal: Circulation Date: 2018-09-04 Impact factor: 29.690
Authors: Rozh H Al-Mashhadi; Lars P Tolbod; Lars Ø Bloch; Martin M Bjørklund; Zahra P Nasr; Zheer Al-Mashhadi; Michael Winterdahl; Jørgen Frøkiær; Erling Falk; Jacob F Bentzon Journal: J Am Coll Cardiol Date: 2019-09-03 Impact factor: 24.094
Authors: Joshua G Travers; Fadia A Kamal; Jeffrey Robbins; Katherine E Yutzey; Burns C Blaxall Journal: Circ Res Date: 2016-03-18 Impact factor: 17.367
Authors: Eleanor C Wicks; Leon J Menezes; Anna Barnes; Saidi A Mohiddin; Neha Sekhri; Joanna C Porter; Helen L Booth; Emily Garrett; Riyaz S Patel; Menelaos Pavlou; Ashley M Groves; Perry M Elliott Journal: Eur Heart J Cardiovasc Imaging Date: 2018-07-01 Impact factor: 6.875
Authors: Marc R Dweck; Ronan Abgral; Maria Giovanna Trivieri; Philip M Robson; Nicolas Karakatsanis; Venkatesh Mani; Anna Palmisano; Marc A Miller; Anuradha Lala; Helena L Chang; Javier Sanz; Johanna Contreras; Jagat Narula; Valentin Fuster; Maria Padilla; Zahi A Fayad; Jason C Kovacic Journal: JACC Cardiovasc Imaging Date: 2017-06-14