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Extracellular Volume in Primary Mitral Regurgitation.
Danai Kitkungvan1, Eric Y Yang2, Kinan C El Tallawi2
1Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA; Division of Cardiovascular Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA.
JACC. Cardiovascular Imaging
|December 20, 2020
Summary
Elevated extracellular volume (ECV) in mitral regurgitation (MR) is linked to disease severity, not mitral valve prolapse (MVP) itself. This finding highlights ECV as a predictor of MR symptoms and adverse clinical events.
Area of Science:
- Cardiovascular imaging and diagnostics
- Cardiac fibrosis assessment
- Mitral valve disease research
Background:
- Replacement fibrosis is common in mitral valve prolapse (MVP) with primary mitral regurgitation (MR).
- Limited data exist on extracellular volume (ECV) as a marker for diffuse interstitial fibrosis in primary MR.
Purpose of the Study:
- To investigate the association between elevated ECV and MVP.
- To determine if elevated ECV is a consequence of remodeling independent of MR etiology.
- To assess ECV's relationship with MR symptoms and clinical outcomes.
Main Methods:
- Cardiovascular magnetic resonance (CMR) phenotyping was performed on 424 patients with primary MR.
- Patients were stratified into MVP and non-MVP cohorts based on leaflet displacement.
- Factors associated with ECV and replacement fibrosis were analyzed, along with ECV's link to symptoms and clinical events.
Main Results:
- Replacement fibrosis was significantly more prevalent in the MVP cohort (34.1%) compared to the non-MVP cohort (6.7%).
- ECV increased with MR severity similarly in both MVP and non-MVP groups, indicating an association with MR severity, not MVP itself.
- Elevated ECV was independently associated with MR-related symptoms and clinical events, including mitral surgery and cardiovascular death.
Conclusions:
- Diffuse interstitial fibrosis, indicated by ECV, is associated with MR severity irrespective of the primary MR cause.
- ECV is a significant independent predictor of symptoms and adverse clinical outcomes in patients with primary MR.
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