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The International Journal of Cardiovascular Imaging

Erschienen in:

28.10.2023 | Original Paper

Left ventricular fibrosis and CMR tissue characterization of papillary muscles in mitral valve prolapse patients

verfasst von: Ricardo A. Spampinato, Mateo Marin-Cuartas, Antonia van Kampen, Florian Fahr, Franz Sieg, Elfriede Strotdrees, Cosima Jahnke, Kristin Klaeske, Karoline Wiesner, Jordan E. Morningstar, Yasufumi Nagata, David Izquierdo-Garcia, Maja-Theresa Dieterlen, Russell A. Norris, Robert A. Levine, Ingo Paetsch, Michael A. Borger

Erschienen in: The International Journal of Cardiovascular Imaging | Ausgabe 2/2024

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Abstract

Purpose

Mitral valve prolapse (MVP) is associated with left ventricle (LV) fibrosis, including the papillary muscles (PM), which is in turn linked to malignant arrhythmias. This study aims to evaluate comprehensive tissue characterization of the PM by cardiovascular magnetic resonance (CMR) imaging and its association with LV fibrosis observed by intraoperative biopsies.

Methods

MVP patients with indication for surgery due to severe mitral regurgitation (n = 19) underwent a preoperative CMR with characterization of the PM: dark-appearance on cine, T1 mapping, conventional bright blood (BB) and dark blood (DB) late gadolinium enhancement (LGE). CMR T1 mapping was performed on 21 healthy volunteers as controls. LV inferobasal myocardial biopsies were obtained in MVP patients and compared to CMR findings.

Results

MVP patients (54 ± 10 years old, 14 male) had a dark-appearance of the PM with higher native T1 and extracellular volume (ECV) values compared with healthy volunteers (1096 ± 78ms vs. 994 ± 54ms and 33.9 ± 5.6% vs. 25.9 ± 3.1%, respectively, p < 0.001). Seventeen MVP patients (89.5%) had fibrosis by biopsy. BB-LGE + in LV and PM was identified in 5 (26.3%) patients, while DB-LGE + was observed in LV in 9 (47.4%) and in PM in 15 (78.9%) patients. DB-LGE + in PM was the only technique that showed no difference with detection of LV fibrosis by biopsy. Posteromedial PM was more frequently affected than the anterolateral (73.7% vs. 36.8%, p = 0.039) and correlated with biopsy-proven LV fibrosis (Rho 0.529, p = 0.029).

Conclusions

CMR imaging in MVP patients referred for surgery shows a dark-appearance of the PM with higher T1 and ECV values compared with healthy volunteers. The presence of a positive DB-LGE at the posteromedial PM by CMR may serve as a better predictor of biopsy-proven LV inferobasal fibrosis than conventional CMR techniques.

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Titel: Left ventricular fibrosis and CMR tissue characterization of papillary muscles in mitral valve prolapse patients
verfasst von: Ricardo A. Spampinato
Mateo Marin-Cuartas
Antonia van Kampen
Florian Fahr
Franz Sieg
Elfriede Strotdrees
Cosima Jahnke
Kristin Klaeske
Karoline Wiesner
Jordan E. Morningstar
Yasufumi Nagata
David Izquierdo-Garcia
Maja-Theresa Dieterlen
Russell A. Norris
Robert A. Levine
Ingo Paetsch
Michael A. Borger
Publikationsdatum: 28.10.2023
Verlag: Springer Netherlands
Erschienen in: The International Journal of Cardiovascular Imaging / Ausgabe 2/2024
Print ISSN: 1569-5794
Elektronische ISSN: 1875-8312
DOI: https://doi.org/10.1007/s10554-023-02985-w

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Left ventricular fibrosis and CMR tissue characterization of papillary muscles in mitral valve prolapse patients

Abstract

Purpose

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