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Resolving the Disproportionate Left Ventricular Enlargement in Mitral Valve Prolapse Due to Barlow Disease: Insights

K Carlos El-Tallawi1, Danai Kitkungvan2, Jiaqiong Xu3

  • 1Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA.

JACC. Cardiovascular Imaging
|November 1, 2020
PubMed

Insights

Prolapse volume contributes to total volume load in Barlow disease, explaining disproportionate left ventricular enlargement. Accounting for this volume load improves understanding of heart chamber remodeling.

Area of Science:

  • Cardiology
  • Cardiac Imaging
  • Valvular Heart Disease

Background:

  • Barlow disease features elongated mitral leaflets, leading to significant end-systolic prolapse volume.
  • Left ventricular (LV) enlargement in Barlow disease can appear disproportionate to mitral regurgitation (MR) severity, raising concerns about Barlow cardiomyopathy.

Purpose of the Study:

  • To investigate if total volume load, including transvalvular MR and prolapse volume, explains LV enlargement in Barlow disease.
  • To compare MR, prolapse volume, and cardiac remodeling between bileaflet prolapse (BLP) and single leaflet prolapse (SLP) using cardiac magnetic resonance (CMR).

Main Methods:

  • Cardiac magnetic resonance (CMR) was employed to assess patients with Barlow disease.
  • Evaluated mitral regurgitation (MR), prolapse volume, and cardiac chamber remodeling in 157 patients (81 BLP, 76 SLP).

Main Results:

  • Bileaflet prolapse (BLP) patients exhibited larger LV end-diastolic volume and prolapse volume despite similar transvalvular MR compared to single leaflet prolapse (SLP).
  • Total volume load, incorporating prolapse volume, correlated better with LV end-diastolic volume in BLP patients.
  • A multivariable model including prolapse volume provided a superior explanation for left heart chamber enlargement than MR alone.

Conclusions:

  • Prolapse volume is a critical component of the total volume load in Barlow disease.
  • This understanding helps explain the disproportionate LV enlargement observed in Barlow disease relative to MR severity.
Abstract

Keywords:
Barlow diseasecardiac magnetic resonancemitral regurgitationmitral valve prolapse

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