Abnormal Mechanics Relate to Myocardial Fibrosis and Ventricular Arrhythmias in Patients With Mitral Valve Prolapse. (2nd December 2022)

• Record Type: Journal Article
• Authors: Nagata, Yasufumi; Bertrand, Philippe B.; Baliyan, Vinit; Kochav, Jonathan; Kagan, Ruth D.; Ujka, Kristian; Alfraidi, Hassan; van Kampen, Antonia; Morningstar, Jordan E.; Dal-Bianco, Jacob P.; Melnitchouk, Serguei; Holmvang, Godtfred; Borger, Michael A.; Moore, Reece; Hua, Lanqi; Sultana, Razia; Calle, Pablo Villar; Yum, Brian; Guerrero, J. Luis; Neilan, Tomas G.; Picard, Michael H.; Kim, Jiwon; Delling, Francesca N.; Hung, Judy; Norris, Russell A.; Weinsaft, Jonathan W.; Levine, Robert A.
• Is Part Of: Circulation. Volume 16:Number 4(2023)
• Page Start: e014963
• Publication Date: 2022-12-02
• Subjects: arrhythmia -- echocardiography -- fibrosis -- magnetic resonance imaging -- mechanics -- mitral valve prolapse -- papillary muscles; Cardiovascular system -- Imaging -- Periodicals; Heart -- Imaging -- Periodicals; 616.1075405
• DOI: 10.1161/CIRCIMAGING.122.014963
• Languages: English
• ISSNs: 1941-9651

Abstract

Abstract : Background: The relation between ventricular arrhythmia and fibrosis in mitral valve prolapse (MVP) is reported, but underlying valve-induced mechanisms remain unknown. We evaluated the association between abnormal MVP-related mechanics and myocardial fibrosis, and their association with arrhythmia. Methods: We studied 113 patients with MVP with both echocardiogram and gadolinium cardiac magnetic resonance imaging for myocardial fibrosis. Two-dimensional and speckle-tracking echocardiography evaluated mitral regurgitation, superior leaflet and papillary muscle displacement with associated exaggerated basal myocardial systolic curling, and myocardial longitudinal strain. Follow-up assessed arrhythmic events (nonsustained or sustained ventricular tachycardia or ventricular fibrillation). Results: Myocardial fibrosis was observed in 43 patients with MVP, predominantly in the basal-midventricular inferior-lateral wall and papillary muscles. Patients with MVP with fibrosis had greater mitral regurgitation, prolapse, and superior papillary muscle displacement with basal curling and more impaired inferior-posterior basal strain than those without fibrosis ( P <0.001). An abnormal strain pattern with distinct peaks pre–end-systole and post–end-systole in inferior-lateral wall was frequent in patients with fibrosis (81 versus 26%, P <0.001) but absent in patients without MVP with basal inferior-lateral wall fibrosis (n=20). During median follow-up of 1008 days, 36 of 87 patients with MVP with >6-month follow-up developed ventricular arrhythmias associated (univariable) with fibrosis, greater prolapse, mitral annular disjunction, and double-peak strain. In multivariable analysis, double-peak strain showed incremental risk of arrhythmia over fibrosis. Conclusions: Basal inferior-posterior myocardial fibrosis in MVP is associated with abnormal MVP-related myocardial mechanics, which are potentially associated with ventricular arrhythmia. These associations suggest pathophysiological links between MVP-related mechanical abnormalities and myocardial fibrosis, which also may relate to ventricular arrhythmia and offer potential imaging markers of increased arrhythmic risk.