What does this research mean for the field?

Patients with mitral valve prolapse and mitral annular disjunction have significantly higher myocardial extracellular volume compared to controls, indicating increased interstitial fibrosis that correlates with arrhythmia risk even in the absence of late gadolinium enhancement. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

March 1, 2021Journal of Cardiovascular Magnetic ResonanceOpen Access

Myocardial extracellular volume by T1 mapping: a new marker of arrhythmia in mitral valve prolapse

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Mitral valve prolapse (MVP) with mitral annular disjunction (MAD) (n=54). Intervention: Mitral valve prolapse with mitral annular disjunction (MVP-MAD) vs. Mitral regurgitation without MAD (MR-NoMAD) and normal CMR (NoMR-NoMAD). Primary outcome: Basal segments myocardial extracellular volume (ECVsyn) (p=<0.001).

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Key result

MVP and MAD are linked to ~25% higher myocardial ECV, indicating increased interstitial fibrosis.

P<0.001
n=54

Why the study?

In MVP, MAD has been associated with replacement fibrosis and arrhythmia, but the importance of interstitial fibrosis remains unknown.

Does myocardial extracellular volume (ECVsyn) by T1 mapping correlate with mitral annular disjunction severity and identify arrhythmic risk in patients with mitral valve prolapse?

Population

30 patients with MVP and MAD, 14 MR controls without MAD, and 10 normal CMR controls

Comparison

MVP-MAD vs MR-NoMAD vs normal CMR controls

Design

Retrospective study

Authors

APAnna Giulia PavonCardiac Imaging DADimitri ArangalageUniversité Claude Bernard Lyon 1 PPPatrizio PascaleElectrophysiology

Discussion

Member takes

Implication

Elevated ECV was associated with arrhythmic risk in MVP-MAD; hypothesis-generating for T1 mapping-guided stratification.

Study Design

Type

Observational (n=54)

Multicenter

Structured PICO

Does myocardial extracellular volume (ECVsyn) by T1 mapping correlate with mitral annular disjunction severity and identify arrhythmic risk in patients with mitral valve prolapse?

Population

54 patients, including 30 with bileaflet mitral valve prolapse and mitral annular disjunction (MVP-MAD), 14 with mitral regurgitation but no MAD (MR-NoMAD), and 10 with normal CMR (NoMR-NoMAD). Mean age 50, 43% female.

Intervention

Cardiovascular magnetic resonance (CMR) with assessment of MAD length, late gadolinium enhancement (LGE), and basal segments myocardial extracellular volume (ECVsyn) by T1 mapping

Comparator

Patients with mitral regurgitation but no MAD (MR-NoMAD) and patients with normal CMR (NoMR-NoMAD)

Outcome

Relationship between MAD severity and myocardial interstitial fibrosis (ECVsyn) at the LV base, and association between severity of interstitial fibrosis and occurrence of ventricular arrhythmic events (OHCA)surrogate

Main Result

Absolute Event Rate: 30% vs 24%

p-value: p=<0.001

Myocardial extracellular volume (ECVsyn) by T1 mapping is increased in patients with mitral valve prolapse and mitral annular disjunction, correlating with disjunction length and identifying patients at high risk for out-of-hospital cardiac arrest even without late gadolinium enhancement.

Limitations

Observational, retrospective study with a limited number of patients.
Likely selection bias toward higher arrhythmic risk.
Routine evaluation of fibrosis in the papillary muscles area was not part of the analysis.
Mitral regurgitation severity was not systematically evaluated during CMR examinations.
No histologic confirmation of interstitial or replacement fibrosis could be obtained.
Patients underwent CMR examination in two different scanners.

Cite This Study

Pavon et al. (2021) conducted an observational in Mitral valve prolapse (MVP) with mitral annular disjunction (MAD) (n=54). Mitral valve prolapse with mitral annular disjunction (MVP-MAD) vs. Mitral regurgitation without MAD (MR-NoMAD) and normal CMR (NoMR-NoMAD) was evaluated on Basal segments myocardial extracellular volume (ECVsyn) (p=<0.001). Patients with mitral valve prolapse and mitral annular disjunction had significantly higher myocardial extracellular volume compared to controls (30% vs 24%, p<0.001), indicating increased interstitial fibrosis.

synapsesocial.com/papers/6a15922279ff98d0de4ed448 https://doi.org/10.1186/s12968-021-00797-2

Topics

Mitral valve intervention

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March 1, 2021Journal of Cardiovascular Magnetic ResonanceOpen Access

Myocardial extracellular volume by T1 mapping: a new marker of arrhythmia in mitral valve prolapse

View Full Paper

Ask AI

Bookmark

Key result

MVP and MAD are linked to ~25% higher myocardial ECV, indicating increased interstitial fibrosis.

P<0.001
n=54

Why the study?

In MVP, MAD has been associated with replacement fibrosis and arrhythmia, but the importance of interstitial fibrosis remains unknown.

Does myocardial extracellular volume (ECVsyn) by T1 mapping correlate with mitral annular disjunction severity and identify arrhythmic risk in patients with mitral valve prolapse?

Population

30 patients with MVP and MAD, 14 MR controls without MAD, and 10 normal CMR controls

Comparison

MVP-MAD vs MR-NoMAD vs normal CMR controls

Design

Retrospective study

Authors

APAnna Giulia PavonCardiac Imaging DADimitri ArangalageUniversité Claude Bernard Lyon 1 PPPatrizio PascaleElectrophysiology

Discussion

Member takes

Implication

Elevated ECV was associated with arrhythmic risk in MVP-MAD; hypothesis-generating for T1 mapping-guided stratification.

Study Design

Type

Observational (n=54)

Multicenter

Structured PICO

Does myocardial extracellular volume (ECVsyn) by T1 mapping correlate with mitral annular disjunction severity and identify arrhythmic risk in patients with mitral valve prolapse?

Population

Intervention

Cardiovascular magnetic resonance (CMR) with assessment of MAD length, late gadolinium enhancement (LGE), and basal segments myocardial extracellular volume (ECVsyn) by T1 mapping

Comparator

Patients with mitral regurgitation but no MAD (MR-NoMAD) and patients with normal CMR (NoMR-NoMAD)

Outcome

Main Result

Absolute Event Rate: 30% vs 24%

p-value: p=<0.001

Limitations

Observational, retrospective study with a limited number of patients.
Likely selection bias toward higher arrhythmic risk.
Routine evaluation of fibrosis in the papillary muscles area was not part of the analysis.
Mitral regurgitation severity was not systematically evaluated during CMR examinations.
No histologic confirmation of interstitial or replacement fibrosis could be obtained.
Patients underwent CMR examination in two different scanners.

Cite This Study

synapsesocial.com/papers/6a15922279ff98d0de4ed448 https://doi.org/10.1186/s12968-021-00797-2

Also Consider

Synapse has enriched 4 closely related papers on similar clinical questions. Consider them for comparative context:

Topics

Mitral valve intervention

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