Myocardial fibrosis in asymptomatic and symptomatic chronic severe primary mitral regurgitation and relationship to tissue characterisation and left ventricular function on cardiovascular magnetic resonance

Figures

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  Fig. 1. Boxplots illustrating the distribution of mean collagen volume fraction (CVFmean) (top) and cardiomyocyte cross sectional area (CSA) (bottom) in autopsy controls vs. asymptomatic and symptomatic mitral regurgitation (MR) patients. P values are derived from Mann–Whitney U tests for non-parametric variables (collagen volume fraction) and independent T-test for parametric variables (cardiomyocyte cross sectional area, extracellular volume). MR mitral regurgitation

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  Fig. 2. Histological specimens from mitral regurgitation patients and controls. Sections are stained with Masson Trichrome highlighting fibrous tissue as blue and myocytes as purple-red. Histological fibrosis is patchy with little congruence in fibrosis burden across different biopsy sites. Extracellular volume fraction (ECV) can provide an overall estimation of myocardial status, but fails to account for endocardial fibrosis

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  Fig. 3. Relationship between ECV and histological evidence of interstitial fibrosis on biopsy (CVFmean) for a all biopsies, and b biopsies containing only myocardium. The trendlines are based on regression models, with ECV as the independent variable, and Log2CVFmean as the independent variable. This relationship was not found to be statistically significant when all biopsies were included within analyses (a, Rho = 0.18, P = 0.101, N = 83), but became statistically significant when limiting analyses to biopsies that contained only myocardium (b, Rho = 0.33, P = 0.015, N = 56)