Myocardial Fibrosis in Patients With Primary Mitral Regurgitation With and Without Prolapse
Danai Kitkungvan1, Faisal Nabi2, Raymond J Kim3
1Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas; Division of Cardiovascular Medicine, McGovern Medical School, University of Texas Health and Science Center at Houston, Houston, Texas.
Background:
Recent studies reported left ventricular (LV) fibrosis in patients with primary mitral regurgitation (MR) thought to be principally due to mitral valve prolapse (MVP).
Objectives:
This study sought to evaluate the prevalence, characteristics, and prognostic implications of LV fibrosis in a large cohort of primary MR patients with and without MVP using cardiovascular magnetic resonance (CMR).
Methods:
Patients referred for contrast CMR assessment of chronic primary MR were enrolled and underwent comprehensive assessment of cardiac remodeling, severity of MR, and LV replacement fibrosis. Primary MR patients were stratified into: an MVP group if there was >2 mm mitral leaflet displacement on cine-CMR, or a non-MVP group. Patients were followed for arrhythmic events (sudden cardiac death, aborted sudden cardiac arrest, and sustained or inducible ventricular arrhythmia).
Results:
A total of 356 primary MR patients (177 MVP and 179 non-MVP) were enrolled. LV fibrosis was more prevalent in the MVP group than the non-MVP group (36.7% vs. 6.7%; p < 0.001). The presence of MVP had the strongest association (odds ratio: 6.82; p < 0.001) with LV fibrosis even after adjustment for clinical variables, measures of cardiac remodeling, and MR severity. During follow-up (median 1,354 days), MVP patients with LV fibrosis had the highest event rate for arrhythmic events.
Conclusions:
In primary MR patients, LV fibrosis is more prevalent in MVP than non-MVP, suggesting a unique pathophysiology beyond volume overload in MVP. LV fibrosis in primary MR may represent a risk marker of arrhythmic events.
Insights
Left ventricular (LV) fibrosis is significantly more common in patients with primary mitral regurgitation (MR) and mitral valve prolapse (MVP). This cardiac fibrosis in primary MR patients may indicate a higher risk for arrhythmic events.
Area of Science:
- Cardiology
- Cardiac Imaging
- Pathophysiology
Background:
- Left ventricular (LV) fibrosis has been observed in primary mitral regurgitation (MR) patients.
- This fibrosis was previously thought to be primarily linked to mitral valve prolapse (MVP).
Purpose of the Study:
- To determine the prevalence and characteristics of LV fibrosis in primary MR patients.
- To investigate the prognostic significance of LV fibrosis in relation to arrhythmic events.
- To compare LV fibrosis in primary MR patients with and without MVP using cardiovascular magnetic resonance (CMR).
Main Methods:
- 356 patients with chronic primary MR underwent CMR for cardiac remodeling and LV fibrosis assessment.
- Patients were categorized into MVP (>2 mm leaflet displacement) and non-MVP groups.
- Follow-up for arrhythmic events included sudden cardiac death, aborted cardiac arrest, and ventricular arrhythmias.
Main Results:
- LV fibrosis was more prevalent in the MVP group (36.7%) compared to the non-MVP group (6.7%; p < 0.001).
- MVP was the strongest predictor of LV fibrosis (OR: 6.82; p < 0.001), independent of other factors.
- MVP patients with LV fibrosis experienced the highest rate of arrhythmic events during follow-up.
Conclusions:
- LV fibrosis is more common in primary MR patients with MVP, suggesting a distinct pathophysiology beyond volume overload.
- LV fibrosis in primary MR may serve as a significant risk marker for future arrhythmic events.
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