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Diffuse myocardial fibrosis in patients with mitral valve prolapse and ventricular arrhythmia

An H Bui1,2, Sébastien Roujol2, Murilo Foppa2,3

  • 1Cardiovascular Division, Department of Medicine, Harvard-Thorndike Electrophysiology Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.

Heart (British Cardiac Society)
|August 13, 2016
PubMed

Insights

Mitral valve prolapse (MVP) may indicate diffuse left ventricular (LV) myocardial fibrosis, detected by cardiac magnetic resonance (CMR) T1 imaging. This fibrosis is linked to arrhythmias, even without visible scarring.

Area of Science:

  • Cardiology
  • Cardiovascular Imaging
  • Medical Research

Background:

  • Mitral valve prolapse (MVP) is a common condition.
  • The relationship between myocardial fibrosis and complex ventricular arrhythmias (ComVA) in MVP is not fully understood.
  • Cardiac magnetic resonance (CMR) T1 imaging offers a method to assess diffuse myocardial fibrosis.

Purpose of the Study:

  • To investigate the association between diffuse myocardial fibrosis, assessed by CMR T1, and ComVA in patients with MVP.
  • To compare T1 times in MVP patients with and without ComVA, and with healthy controls.

Main Methods:

  • Retrospective analysis of 41 MVP patients and 31 controls undergoing CMR.
  • Measurement of left ventricular (LV) septal T1 times post-contrast administration.
  • Arrhythmia analysis using Holter/event monitors in 23 MVP patients.
  • Assessment of Late Gadolinium Enhancement (LGE) for focal fibrosis.

Main Results:

  • MVP patients had significantly shorter postcontrast T1 times than controls (334±52 vs 363±58 ms; p=0.03).
  • Patients with MVP and ComVA had shorter T1 times compared to those without ComVA (324 vs 354 ms; p=0.03).
  • Only 36% of MVP patients with ComVA showed evidence of papillary muscle LGE, suggesting diffuse fibrosis.

Conclusions:

  • Reduced postcontrast T1 times suggest diffuse LV myocardial fibrosis in MVP.
  • This diffuse interstitial derangement may contribute to ComVA in MVP, even without focal fibrosis.
  • CMR T1 imaging is a valuable tool for assessing myocardial fibrosis in MVP and its association with arrhythmias.
Abstract

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