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Feature tracking myocardial strain analysis in patients with bileaflet mitral valve prolapse: relationship with LGE and arrhythmias

  • Cardiac
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Abstract

Objectives

Anatomical substrate and mechanical trigger co-act in arrhythmia’s onset in patients with bileaflet mitral valve prolapse (bMVP). Feature tracking (FT) may improve risk stratification provided by cardiac magnetic resonance (CMR). The aim was to investigate differences in CMR and FT parameters in bMVP patients with and without complex arrhythmias (cVA and no-cVA).

Methods

In this retrospective study, 52 patients with bMVP underwent 1.5 T CMR and were classified either as no-cVA (n = 32; 12 males; 49.6 ± 17.4 years) or cVA (n = 20; 3 males; 44.7 ± 11.2 years), the latter group including 6 patients (1 male; 45.7 ± 12.7 years) with sustained ventricular tachycardia or ventricular fibrillation (SVT-FV). Twenty-four healthy volunteers (11 males, 36.2 ± 12.5 years) served as control. Curling, prolapse distance, mitral annulus disjunction (MAD), and late gadolinium enhancement (LGE) were recorded and CMR-FT analysis performed. Statistical analysis included non-parametric tests and binary logistic regression.

Results

LGE and MAD distance were associated with cVA with an odds ratio (OR) of 8.51 for LGE (95% CI 1.76, 41.28; p = 0.008) and of 1.25 for MAD (95% CI 1.02, 1.54; p = 0.03). GLS 2D (− 11.65 ± 6.58 vs − 16.55 ± 5.09 1/s; p = 0.04), PSSR longitudinal 2D (0.04 ± 1.62 1/s vs − 1.06 ± 0.35 1/s; p = 0.0001), and PSSR radial 3D (3.95 ± 1.97 1/s vs 2.64 ± 1.03 1/s; p = 0.0001) were different for SVT-VF versus the others. PDSR circumferential 2D (1.10 ± 0.54 vs. 0.84 ± 0.34 1/s; p = 0.04) and 3D (0.94 ± 0.42 vs. 0.69 ± 0.17 1/s; p = 0.04) differed between patients with and without papillary muscle LGE.

Conclusions

CMR-FT allowed identifying subtle myocardial deformation abnormalities in bMVP patients at risk of SVT-VF. LGE and MAD distance were associated with cVA.

Key Points

• CMR-FT allows identifying several subtle myocardial deformation abnormalities in bMVP patients, especially those involving the papillary muscle.

• CMR-FT allows identifying subtle myocardial deformation abnormalities in bMVP patients at risk of SVT and VF.

• In patients with bMVP, the stronger predictor of cVA is LGE (OR = 8.51; 95% CI 1.76, 41.28; p = 0.008), followed by MAD distance (OR = 1.25; 95% CI 1.02, 1.54; p = 0.03).

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Abbreviations

bMVP:

Bileaflet mitral valve prolapse

cVA:

Complex ventricular arrhythmias

EF:

Ejection fraction

FT:

Feature tracking

GCS:

Global circumferential strain

GLS:

Global longitudinal strain

GRS:

Global radial strain

HC:

Healthy control

MAD:

Mitral annulus disjunction

MVP:

Mitral valve prolapse

no-cVA:

Non-complex ventricular arrhythmias

PD:

Prolapse distance

PDSR:

Peak diastolic strain rate

PSSR:

Peak systolic strain rate

SVT:

Sustained ventricular tachycardia

VA:

Ventricular arrhythmia

VF:

Ventricular fibrillation

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Funding

The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Radiology Unit, Department of Surgical Sciences, University of Turin, Turin, Italy

    Marco Gatti, Stefano Fiore, Paolo Fonio & Riccardo Faletti

  2. Experimental Imaging Centre, Radiology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy

    Anna Palmisano, Antonio Esposito & Francesco De Cobelli

  3. School of Medicine, Vita-Salute San Raffaele University, Milan, Italy

    Anna Palmisano, Antonio Esposito & Francesco De Cobelli

  4. Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy

    Caterina Beatrice Monti

  5. Division of Cardiology, Department of Medical Sciences, University of Turin, Turin, Italy

    Alessandro Andreis, Lorenzo Pistelli & Carla Giustetto

  6. Arrhythmias and Cardiac Electrophysiology, Ospedale San Raffaele, Milan, Italy

    Pasquale Vergara

  7. Department of Surgical Sciences, University of Turin, Turin, Italy

    Laura Bergamasco

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  1. Marco Gatti
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Corresponding author

Correspondence to Antonio Esposito.

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Guarantor

The scientific guarantor of this publication is Riccardo Faletti.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors has significant statistical expertise.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.

Study subjects or cohorts overlap

Healthy volunteer cohort has been previously reported in Gatti M, Palmisano A, Faletti R, Benedetti G, Bergamasco L, Bioletto F, Peretto G, Sala S, De Cobelli F, Fonio P, Esposito A. Two-dimensional and three-dimensional cardiac magnetic resonance feature-tracking myocardial strain analysis in acute myocarditis patients with preserved ejection fraction. Int J Cardiovasc Imaging. 2019;35:1101–1109.

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• Retrospective

• Case-control study

• Multicenter study

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Gatti, M., Palmisano, A., Esposito, A. et al. Feature tracking myocardial strain analysis in patients with bileaflet mitral valve prolapse: relationship with LGE and arrhythmias. Eur Radiol 31, 7273–7282 (2021). https://doi.org/10.1007/s00330-021-07876-z

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  • DOI: https://doi.org/10.1007/s00330-021-07876-z

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