What is the clinical evidence from this study?

Study design: Cohort. Population: Mitral valve prolapse (n=45). Intervention: Myocardial late gadolinium enhancement (M-LGE) ≥ 5% of LV mass vs. M-LGE 10%) or multiform PVC, ventricular arrhythmia ablation, or ICD insertion (OR 13.41, 95% CI 1.49-120.67, p=0.02).

What does this research mean for the field?

Myocardial late gadolinium enhancement detected by cardiac MRI, particularly when involving 5% or more of left ventricular mass, is strongly associated with an increased risk of ventricular arrhythmias in patients with mitral valve prolapse. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To identify associations between cardiac MRI-based findings, particularly myocardial late gadolinium enhancement, and significant ventricular arrhythmias in patients with mitral valve prolapse.

September 18, 2026The International Journal of Cardiovascular ImagingOpen Access

Myocardial late gadolinium enhancement is strongly associated with ventricular arrhythmias in mitral valve prolapse

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Key result

Myocardial LGE ≥5% of LV mass linked to ~13-fold higher ventricular arrhythmia risk in MVP.

OR 13.41
95% CI 1.49-120.67
P=0.02
n=45

Why the study?

The prognosis of patients with mitral valve prolapse largely depends on the presence of ventricular arrhythmias, and the association between CMR-based findings and ventricular arrhythmias in MVP patients was unclear.

Key Points

To identify associations between cardiac MRI-based findings, particularly myocardial late gadolinium enhancement, and significant ventricular arrhythmias in patients with mitral valve prolapse.
Evaluated consecutive patients with mitral valve prolapse (N = 45, mean age 56 ± 17 years) who underwent cardiac magnetic resonance imaging, 24-hour Holter monitoring, and exercise stress testing.
Quantified myocardial late gadolinium enhancement (M-LGE) as a percentage of left ventricular mass, categorizing findings into tertiles: 1st tertile (0%), 2nd tertile (1–4%), and 3rd tertile (≥ 5%).
Assessed a combined clinical endpoint (CEP) defined as ventricular tachycardia, multiple (> 10%) or multiform premature ventricular beats, arrhythmia ablation, or implantable cardioverter defibrillator insertion.
The combined clinical endpoint occurred in 47% of patients in the 1st M-LGE tertile, 46% in the 2nd tertile, and 93% in the 3rd tertile (p = 0.014).
Multivariable logistic regression demonstrated that M-LGE percentage was strongly associated with the endpoint as a continuous variable (OR 1.43, 95% CI 1.05–1.94, p = 0.02).
In a multivariable model adjusting for left ventricular ejection fraction and papillary muscle fibrosis, the 3rd M-LGE tertile independently predicted the clinical endpoint (OR 13.41, 95% CI 1.49–120.67, p = 0.02).

Study Design

Type

Cohort (n=45)

Multicenter

Structured PICO

Population

45 patients (mean age 56 years, 44% female) with mitral valve prolapse who underwent cardiac MRI, evaluated for arrhythmic events within 12 months.

Exposure

Myocardial late gadolinium enhancement (M-LGE) quantification by Cardiac MRI (CMR), analyzed as a continuous variable and by tertiles (1st: 0%, 2nd: 1-4%, 3rd: ≥5% of left ventricular mass).

Comparator

Patients with lower or no M-LGE (1st and 2nd tertiles, <5% of left ventricular mass).

Outcome

Combined clinical endpoint (CEP) defined as premature ventricular complexes (PVC) > 10% of all heart beats, multiform PVC, history of ventricular arrhythmia ablation, VT (sustained or non-sustained), or implantable cardioverter defibrillator (ICD) insertion within 12 months of the analyzed CMR scan.composite

Main Result

Odds Ratio: 13.41 (95% CI 1.49–120.67)

p-value: p=0.02

Limitations

Retrospective, single-center design and modest sample size
Potential selection bias as patients referred for CMR may reflect a higher-risk subgroup
Use of both 1.5T and 3T scanners precluded standardized tissue mapping
Arrhythmia detection relied on standard 24-hour monitoring and one-year follow-up
No serial CMRs were available to assess disease progression
The ≥5% M-LGE cut point was exploratory and not externally validated
Retrospective, single-center design
Modest sample size
Potential selection bias (patients referred for CMR may reflect a higher-risk subgroup)
Use of both 1.5T and 3T scanners precluding standardized tissue mapping
No serial CMRs available to assess disease progression
≥5% M-LGE cut point is exploratory and not externally validated

Implication

Myocardial fibrosis quantified by CMR-LGE, particularly when ≥5% of LV mass, is strongly associated with arrhythmic risk in patients with mitral valve prolapse.

Abstract

The prognosis of patients with mitral valve prolapse (MVP) largely depends on the presence of ventricular arrhythmias. This study aims to identify association between Cardiac MRI (CMR) based findings with ventricular arrhythmias in MVP patients. Consecutive patients ( n = 45, mean age 56 ± 17 y) with MVP underwent CMR scans. Premature ventricular beats (PVC) and ventricular tachycardia (VT) were recorded by 24-hour Holter monitoring and exercise stress testing. Myocardial late gadolinium enhancement (M -LGE) was calculated as percentage of left ventricular (LV) mass and was analyzed by tertiles – 1st tertile (0%), 2nd (1–4%) and 3rd tertile ≥ 5% of the LV mass. Mitral annular disjunction (MAD) was measured in millimeters in a 3-chamber steady state free precession (SSFP) sequence. Papillary muscle fibrosis (PM - LGE) presence was recorded using the LGE sequence. The combined clinical endpoint (CEP) was defined as the presence of VT, multiple (> 10%) or multiform PVC, ablation due to ventricular arrhythmia and implantable cardioverter defibrillator insertion. M-LGE > 0% in 27 patients (64%) was recorded. The CEP was documented in 47%, 46% and 93% of the 1st, 2nd and 3rd M - LGE% tertiles, respectively (p value = 0.014). A multivariable logistic regression analysis assessing associations with CEP, including LV ejection fraction, PM-LGE, and M-LGE%, was performed. M - LGE% remains strongly associated with CEP as a continuous variable, as well as in the 3rd tertile: OR 1.43; 95%CI 1.05–1.94, p = 0.02 and OR 13.41 95%CI 1.49–120.67, p = 0.02, respectively. Myocardial fibrosis detected by CMR - LGE, particularly when ≥ 5% of LV mass was strongly associated with arrhythmic risk in MVP. CMR - based fibrosis quantification should be considered in routine evaluation to improve risk stratification.

Discussion

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Cite This Study

Vedernikov et al. (2026) conducted a cohort in Mitral valve prolapse (n=45). Myocardial late gadolinium enhancement (M-LGE) ≥ 5% of LV mass vs. M-LGE < 5% of LV mass (1st and 2nd tertiles) was evaluated on Combined clinical endpoint (CEP) of VT, multiple (>10%) or multiform PVC, ventricular arrhythmia ablation, or ICD insertion (OR 13.41, 95% CI 1.49-120.67, p=0.02). Myocardial late gadolinium enhancement ≥5% of left ventricular mass was strongly associated with an increased risk of significant ventricular arrhythmias in patients with mitral valve prolapse (OR 13.41).

synapsesocial.com/papers/6aacf5ed0c46fbdff987dd92 https://doi.org/10.1007/s10554-026-03817-3

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Implication

Myocardial fibrosis quantified by CMR-LGE, particularly when ≥5% of LV mass, is strongly associated with arrhythmic risk in patients with mitral valve prolapse.

Myocardial late gadolinium enhancement is strongly associated with ventricular arrhythmias in mitral valve prolapse

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Myocardial late gadolinium enhancement is strongly associated with ventricular arrhythmias in mitral valve prolapse

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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