Replacement Myocardial Fibrosis in Patients With Mitral Valve Prolapse
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Published:2021-05-04
Issue:18
Volume:143
Page:1763-1774
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ISSN:0009-7322
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Container-title:Circulation
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language:en
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Short-container-title:Circulation
Author:
Constant Dit Beaufils Anne-Laure1, Huttin Olivier2, Jobbe-Duval Antoine3ORCID, Senage Thomas34, Filippetti Laura2, Piriou Nicolas3, Cueff Caroline31, Venner Clément2ORCID, Mandry Damien2, Sellal Jean-Marc2, Le Scouarnec Solena2, Capoulade Romain2, Marrec Marie3, Thollet Aurélie32, Beaumont Marine, Hossu Gabriella5, Toquet Claire31, Gourraud Jean-Baptiste31ORCID, Trochu Jean-Noël31, Warin-Fresse Karine3, Marie Pierre-Yves2, Schott Jean-Jacques1ORCID, Roussel Jean-Christian31ORCID, Serfaty Jean-Michel31, Selton-Suty Christine2, Le Tourneau Thierry31ORCID
Affiliation:
1. Université de Nantes, CHU de Nantes, CNRS, INSERM, l’institut du thorax, France (A.-L.C.D.B., C.C., S.L.S., R.C., A.T., C.T., J.-B.G., J.-N.T., J.-J.S., J.-C.R., J.-M. Serfaty, T.L.T.). 2. Service de Cardiologie, Institut Lorrain du Cœur et des Vaisseaux, CHU de Nancy, France (O.H., L.F., C.V., D.M., J.-M. Sellal, P.-Y.M., C.S.-S.). 3. CHU de Nantes, Université de Nantes, l’institut du thorax, CIC 1413, France (A.J.-D., T.S., N.P., C.C., M.M., A.T., C.T., J.-B.G., J.-N.T., K.W.-F., J.-C.R., J.-M. Serfaty, T.L.T.). 4. Biostatistic Department, Université de Nantes, France (T.S.). 5. CIC-IT, U1433, CHRU de Nancy, France; INSERM U1254, Imagerie Adaptative Diagnostique et Interventionnelle, Université de Lorraine, France (G.H.).
Abstract
Background:
Mitral valve prolapse (MVP) is a frequent disease that can be complicated by mitral regurgitation (MR), heart failure, arterial embolism, rhythm disorders, and death. Left ventricular (LV) replacement myocardial fibrosis, a marker of maladaptive remodeling, has been described in patients with MVP, but the implications of this finding remain scarcely explored. We aimed at assessing the prevalence, pathophysiological and prognostic significance of LV replacement myocardial fibrosis through late gadolinium enhancement (LGE) by cardiac magnetic resonance in patients with MVP.
Methods:
Four hundred patients (53±15 years of age, 55% male) with MVP (trace to severe MR by echocardiography) from 2 centers, who underwent a comprehensive echocardiography and LGE cardiac magnetic resonance, were included. Correlates of replacement myocardial fibrosis (LGE+), influence of MR degree, and ventricular arrhythmia were assessed. The primary outcome was a composite of cardiovascular events (cardiac death, heart failure, new-onset atrial fibrillation, arterial embolism, and life-threatening ventricular arrhythmia).
Results:
Replacement myocardial fibrosis (LGE+) was observed in 110 patients (28%; 91 with myocardial wall including 71 with basal inferolateral wall, 29 with papillary muscle). LGE+ prevalence was 13% in trace-mild MR, 28% in moderate MR, and 37% in severe MR, and was associated with specific features of mitral valve apparatus, more dilated LV and more frequent ventricular arrhythmias (45% versus 26%,
P
<0.0001). In trace-mild MR, despite the absence of significant volume overload, abnormal LV dilatation was observed in 16% of patients and ventricular arrhythmia in 25%. Correlates of LGE+ in multivariable analysis were LV mass (odds ratio, 1.01 [95% CI, 1.002–1.017],
P
=0.009) and moderate-severe MR (odds ratio, 2.28 [95% CI, 1.21–4.31],
P
=0.011). LGE+ was associated with worse 4-year cardiovascular event–free survival (49.6±11.7 in LGE+ versus 73.3±6.5% in LGE–,
P
<0.0001). In a stepwise multivariable Cox model, MR volume and LGE+ (hazard ratio, 2.6 [1.4–4.9],
P
=0.002) were associated with poor outcome.
Conclusions:
LV replacement myocardial fibrosis is frequent in patients with MVP; is associated with mitral valve apparatus alteration, more dilated LV, MR grade, and ventricular arrhythmia; and is independently associated with cardiovascular events. These findings suggest an MVP-related myocardial disease. Last, cardiac magnetic resonance provides additional information to echocardiography in MVP.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Physiology (medical),Cardiology and Cardiovascular Medicine
Cited by
99 articles.
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