Left Ventricular Remodelling and Functional Status Across Mitral Regurgitation Severity in Mitral Valve Prolapse

Q: What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Mitral valve prolapse and degenerative mitral regurgitation (n=132). Intervention: Mitral regurgitation severity and CMR myocardial remodelling markers (global native T1, iECV, EDV/LVM-ratio) vs. Healthy controls without MVP or MR / asymptomatic status (NYHA class I). Primary outcome: Symptomatic functional status (NYHA class >= II) associated with indexed extracellular volume (iECV) (OR 1.15, p=0.04).

Q: What does this research mean for the field?

In patients with mitral valve prolapse, functional symptom burden correlates more strongly with cardiovascular magnetic resonance markers of maladaptive left ventricular remodelling and diffuse fibrosis than with mitral regurgitation severity itself. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Klara Lodin; Cristina da Silva; Anne Wang; Ivana Bulatović; Lauge Østergaard; Gabriella Boano; Aristomenis Manouras; Lars H. Lund; Peter K. Svenarud; Magnus Dalén; Marcus Carlsson; Jannike Nickander; Bahira Shahim

doi:10.64898/2026.09.28.26364239

October 1, 2026Open Access

Left Ventricular Remodelling and Functional Status Across Mitral Regurgitation Severity in Mitral Valve Prolapse

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Key result

Higher iECV is linked to ~15% higher odds of symptomatic functional impairment in MVP.

OR 1.15
P=0.04
n=132

Why the study?

Mitral valve prolapse causes mitral regurgitation and maladaptive left ventricular remodelling, prompting a comprehensive CMR characterization of LV remodelling markers across MR severity grades and their association with functional status.

Do CMR markers of maladaptive LV remodelling correlate with mitral regurgitation severity and functional status (NYHA class) in patients with mitral valve prolapse?

Key Points

To comprehensively characterize cardiovascular magnetic resonance markers of maladaptive left ventricular remodelling across mitral regurgitation severity grades in mitral valve prolapse and determine their association with functional status.
Evaluated 112 patients with mitral valve prolapse (23 mild, 48 moderate, and 41 severe mitral regurgitation) and 20 controls using 1.5T cardiovascular magnetic resonance (NCT06255457).
Excluded individuals with significant coronary artery disease, rheumatic valve disease, mitral stenosis, previous mitral valve procedures, endocarditis, or primary cardiomyopathy.
Quantified native T1, T2, extracellular volume, indexed extracellular volume, late gadolinium enhancement, and end-diastolic volume-to-mass ratio, correlating these metrics with NYHA functional class.
Late gadolinium enhancement prevalence (17% in mild vs. 46% in moderate vs. 51% in severe MR vs. 0% in controls) and left ventricular dilatation (46% vs. 67% vs. 88% vs. 15%) increased progressively with regurgitation severity.
Increased indexed end-diastolic volume, late gadolinium enhancement prevalence, higher end-diastolic volume-to-mass ratio, global native T1, and indexed extracellular volume showed the strongest associations with worsening mitral regurgitation.
End-diastolic volume-to-mass ratio, indexed extracellular volume, and global native T1 were independently related to NYHA class ≥II, correlating more strongly with symptom burden than regurgitation severity alone.

Study Design

Type

Cross-Sectional (n=132)

Multicenter

No

Structured PICO

Do CMR markers of maladaptive LV remodelling correlate with mitral regurgitation severity and functional status (NYHA class) in patients with mitral valve prolapse?

P

Population

112 patients with mitral valve prolapse across mild, moderate, and severe mitral regurgitation grades and 20 healthy controls without significant coronary artery disease or cardiomyopathy evaluated by 1.5T cardiovascular magnetic resonance.

E

Exposure

1.5T cardiovascular magnetic resonance (CMR) imaging to quantify global native T1, T2, extracellular volume (ECV), indexed ECV (iECV), indexed intracellular volume (iICV), late gadolinium enhancement (LGE), indexed LV end-diastolic volume (EDVI), and EDV-to-LV mass ratio (EDV/LVM-ratio).

C

Comparator

20 controls, as well as comparisons across MR severity grades (mild <20%, moderate 20–39%, severe ≥40%).

O

Outcome

CMR markers of maladaptive LV remodelling (global native T1, T2, ECV, iECV, iICV, LGE, EDVI, EDV/LVM-ratio) across MR severity grades and their association with functional status assessed by NYHA class.surrogate

Main Result

Odds Ratio: 1.15

p-value: p=0.04

In mitral valve prolapse, CMR markers of maladaptive LV remodelling increase progressively across MR grades, with global native T1, iECV, and EDV/LVM-ratio correlating most strongly with symptom burden (NYHA class ≥II) rather than MR severity alone.

Limitations

Patients with mild or moderate MR underwent CMR in a clinical context, limiting generalizability to an unselected MVP population.
Focal fibrosis was assessed only in the LV myocardium and not in the papillary muscles due to unavailability of dark-blood LGE acquisitions, potentially underestimating focal fibrosis burden.
The cross-sectional design precludes conclusions about causal relationships between MR severity, CMR markers of LV remodelling, and symptom burden.

Implication

CMR markers may refine symptom assessment beyond MR severity in MVP; leaves open prospective validation before guiding management.

Abstract

Background Mitral valve prolapse (MVP) causes mitral regurgitation (MR), leading to volume overload and maladaptive left ventricular (LV) remodelling. Objective To comprehensively characterize markers of maladaptive LV remodelling across MR severity grades in MVP using cardiovascular magnetic resonance (CMR), and their association with functional status. Methods Patients with MVP undergoing 1.5T CMR (2016–2025) were stratified by MR fraction: mild<20%, moderate 20–39%, and severe ≥40%. Exclusion criteria were significant coronary artery disease, rheumatic valve disease, mitral stenosis, previous mitral valve procedures, endocarditis or signs of primary cardiomyopathy. Global native T1, T2, extracellular volume (ECV), indexed ECV (iECV), indexed intracellular volume (iICV), and late gadolinium enhancement (LGE) were quantified. Indexed LV end-diastolic volume (EDVI) and the EDV-to-LV mass ratio (EDV/LVM-ratio) were also calculated as indices of LV remodelling and adaptive hypertrophy. Functional status was assessed by NYHA class. Results Among 112 MVP patients (23 mild, 48 moderate, 41 severe MR) and 20 controls, LGE prevalence (17% vs. 46% vs. 51% vs. 0%) and the proportion with LV dilatation (46% vs. 67% vs. 88% vs 15%) rose progressively with MR severity. Increased EDVI, prevalence of LGE, higher EDV/LVM-ratio, global native T1 and iECV showed the strongest associations with more severe MR, whereas EDV/LVM-ratio, iECV and global native T1 were independently related to NYHA class≥II. Conclusions CMR markers of maladaptive LV remodelling were abnormal across all MR grades and increased markedly with MR severity. Global native T1, iECV and EDV/LVM-ratio correlated most strongly with symptom burden, rather than MR severity per se.

Discussion

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Cite This Study

Lodin et al. (2026) conducted a cross-sectional in Mitral valve prolapse and degenerative mitral regurgitation (n=132). Mitral regurgitation severity and CMR myocardial remodelling markers (global native T1, iECV, EDV/LVM-ratio) vs. Healthy controls without MVP or MR / asymptomatic status (NYHA class I) was evaluated on Symptomatic functional status (NYHA class >= II) associated with indexed extracellular volume (iECV) (OR 1.15, p=0.04). In mitral valve prolapse, LGE prevalence rose with MR severity (17% to 51%), while native T1 (OR 1.02), iECV (OR 1.15), and EDV/LVM-ratio (OR 0.16) independently predicted NYHA class >=II.

synapsesocial.com/papers/6ae28e0ecbadf70daf6c3ff3 https://doi.org/10.64898/2026.09.28.26364239

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Left Ventricular Remodelling and Functional Status Across Mitral Regurgitation Severity in Mitral Valve Prolapse

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Left Ventricular Remodelling and Functional Status Across Mitral Regurgitation Severity in Mitral Valve Prolapse

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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