Interstitial Fibrosis and Arrhythmic Mitral Valve Prolapse: Unravelling Sex-Based Differences
Medrxiv : the Preprint Server for Health Sciences
|January 23, 2024
Summary
Interstitial fibrosis detected by cardiac MRI is linked to ventricular arrhythmias in mitral valve prolapse (MVP). This association is stronger in women, potentially explaining higher rates of severe arrhythmias in females with MVP.
Area of Science:
- Cardiology
- Medical Imaging
- Pathology
Background:
- Mitral valve prolapse (MVP) is associated with arrhythmias, particularly in women.
- Previous studies on interstitial fibrosis in MVP focused on cases with significant mitral regurgitation or mitral annular disjunction.
- The current study investigates interstitial fibrosis and complex ventricular ectopy (ComVE) in a broader MVP population.
Approach:
- Contrast cardiac magnetic resonance (CMR) was used to assess interstitial fibrosis via extracellular volume fraction (ECV%) and late gadolinium enhancement (LGE).
- ComVE was identified using ambulatory ECG monitoring.
- The study included 59 MVP cases unselected for mitral regurgitation severity or mitral annular disjunction.
Key Points:
- Interstitial fibrosis (higher ECV%) was significantly associated with ComVE in MVP patients.
- The association between fibrosis and ComVE was predominantly observed in female patients.
- Higher segmental ECV% was found in various LV segments, not just the typical inferolateral/inferior walls.
Conclusions:
- Cardiac MRI-quantified interstitial fibrosis is linked to an increased risk of ComVE in MVP patients without significant mitral regurgitation.
- The findings suggest a primary myopathic process contributing to arrhythmias in MVP.
- The stronger association in females may explain the higher prevalence of severe arrhythmic complications in women with MVP.
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