Key result
MVP is linked to ~10% higher papillary muscle native T1 on CMR versus healthy controls.
Why the study?
Mitral valve prolapse is associated with left ventricular fibrosis including papillary muscles, but comprehensive CMR tissue characterization and its correlation with biopsy-proven fibrosis are not well established.
Does cardiovascular magnetic resonance (CMR) imaging of the papillary muscles predict biopsy-proven left ventricular fibrosis in patients with severe mitral valve prolapse?
Cross-Sectional (n=40)
Blinded to clinical and echocardiographic data
No
Does cardiovascular magnetic resonance (CMR) imaging of the papillary muscles predict biopsy-proven left ventricular fibrosis in patients with severe mitral valve prolapse?
Dark blood late gadolinium enhancement CMR of the posteromedial papillary muscle may serve as a better predictor of biopsy-proven LV inferobasal fibrosis than conventional CMR techniques in patients with severe mitral valve prolapse.
Answers are grounded in this paper and cite their sources.
DB-LGE at posteromedial PM on CMR was associated with biopsy-proven LV fibrosis in surgical MVP; hypothesis-generating for noninvasive detection, prospective validation needed.
Purpose: Mitral valve prolapse (MVP) is associated with left ventricle (LV) fibrosis, including the papillary muscles (PM), which is in turn linked to malignant arrhythmias. This study aims to evaluate comprehensive tissue characterization of the PM by cardiovascular magnetic resonance (CMR) imaging and its association with LV fibrosis observed by intraoperative biopsies. Methods: MVP patients with indication for surgery due to severe mitral regurgitation (n=19) underwent a preoperative CMR with characterization of the PM: dark-appearance on cine, T1 mapping, conventional bright blood (BB) and dark blood (DB) late gadolinium enhancement (LGE). CMR T1 mapping was performed on 21 healthy volunteers as controls. LV inferobasal myocardial biopsies were obtained in MVP patients and compared to CMR findings. Results: MVP patients (54±10 years old, 14 male) had a dark-appearance of the PM with higher native T1 and extracellular volume (ECV) values compared with healthy volunteers (1096±78ms vs 994±54ms and 33.9±5.6% vs 25.9±3.1%, respectively, p<0.001). Seventeen MVP patients (89.5%) had fibrosis by biopsy. BB-LGE+ in LV and PM was identified in 5 (26.3%) patients, while DB-LGE+ was observed in LV in 9 (47.4%) and in PM in 15 (78.9%) patients. DB-LGE+ in PM was the only technique that showed no difference with detection of LV fibrosis by biopsy. Posteromedial PM was more frequently affected than the anterolateral (73.7% vs 36.8%, p=0.039) and correlated with biopsy-proven LV fibrosis (Rho 0.529, p=0.029). Conclusions: CMR imaging in MVP patients referred for surgery shows a dark-appearance of the PM with higher T1 and ECV values compared with healthy volunteers. The presence of a positive DB-LGE at the posteromedial PM by CMR may serve as a better predictor of biopsy-proven LV inferobasal fibrosis than conventional CMR techniques.
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Spampinato et al. (2023) conducted a cross-sectional in Mitral valve prolapse with severe mitral regurgitation (n=40). Mitral valve prolapse vs. Healthy volunteers was evaluated on Papillary muscle native T1 (p=<0.001). Mitral valve prolapse patients exhibited a dark-appearance of the papillary muscles with higher native T1 (1096 vs 994 ms) and extracellular volume compared to healthy volunteers.
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