Advertisement

Cardiac magnetic resonance in patients with mitral valve prolapse: Focus on late gadolinium enhancement and T1 mapping

  • Silvia Pradella
  • Giulia Grazzini
  • Marta Brandani
  • Linda Calistri
  • Cosimo Nardi
  • Fabio Mori
  • Vittorio Miele
  • Stefano Colagrande
Cardiac

Abstract

Objectives

To evaluate the incidence of late-gadolinium-enhancement (LGE) in mitral valve prolapse (MVP) (in the absence of other heart/valvular diseases), and its association with the degree of mitral regurgitation (MR) and/or with complex ventricular arrhythmia (ComVA), and to analyse the role of T1 mapping in the evaluation of MVP patients.

Methods

We included all consecutive patients with MVP who underwent during 2015–2016 a comprehensive cardiac magnetic resonance (CMR) examination at 1.5 T. We evaluated the association of LGE with the MR fraction and the presence of ComVA. We compared myocardial T1-native and post-contrast times and extracellular volume (ECV)-values between MVP patients, both with and without LGE, and the control group.

Results

Thirty-four patients with MVP were selected (56 ± 14 years old, 59% male). All patients had MR; LGE and ComVA were present in 15 (44%) and 11 (34%) patients, respectively. Significant associations of LGE with both MR severity and ComVA were not found (p=0.72 and 0.79, respectively). T1 mapping confirmed the presence of LGE in all cases. In one patient a thin signal alteration resulted in more evident T1 mapping than LGE. Patients with MVP had higher native T1-values, lower post-contrast T1-values and increased ECV-values compared with controls (p=0.01, 0.01 and 0.00, respectively).

Conclusion

Focal fibrosis with LGE was found in about half the MVP patients and it was independent of the degree of the valve dysfunction and the presence of ComVA. T1 mapping allows diffuse myocardial wall alterations to be identified, but no significant associations between the MR severity and ComVA and T1/ECV values were found.

Key Points

• MVP is a common valvulopathy affecting 2–3% of the general population.

• MVP has been associated with an increased risk of arrhythmic complications and sudden cardiac death.

• CMR is a non-invasive imaging method that provides a precise and more accurate assessment of patients with MVP.

Keywords

Cine magnetic resonance imaging Prolapsed mitral valve Gadolinium T1 mapping 

Abbreviations

2C

2-chamber

3C

3-chamber

4C

4-chamber

AHA

American Heart Association

CMR

Cardiac magnetic resonance

ComVA

Complex ventricular arrhythmias

ECV

Extracellular volume

LGE

Late gadolinium enhancement

LV

Left ventricular

MOLLI

Modified Look-Locker inversion

MR

Mitral regurgitation

MVP

Mitral valve prolapse

PACS

Picture Archiving and Communication System

PSIR

Phase-sensitive inversion recovery

RV

Right ventricular

SA

Short-axis

SCD

Sudden cardiac death

SSFP

Steady-state free processing

SV

Stroke volume

Notes

Funding

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

Compliance with ethical standards

Guarantor

The scientific guarantor of this publication is Prof. Stefano Colagrande.

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

No complex statistical methods were necessary for this paper.

Informed consent

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

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• Retrospective

• Observational

• Performed at one institution

References

  1. 1.
    Freed LA, Levy D, Levine RA et al (1999) Prevalence and Clinical Outcome of Mitral-Valve Prolapse. N Engl J Med 341:1–7CrossRefPubMedGoogle Scholar
  2. 2.
    Basso C, Perazzolo Marra M, Rizzo S et al (2015) Arrhythmic mitral valve prolapse and sudden cardiac death clinical perspective. Circulation 132(7):556–566CrossRefPubMedGoogle Scholar
  3. 3.
    Han Y, Peters DC, Salton CJ et al (2008) Cardiovascular Magnetic Resonance Characterization of Mitral Valve Prolapse. JACC Cardiovasc Imaging 1:294–303CrossRefPubMedGoogle Scholar
  4. 4.
    Nishimura RA, Carabello B (2016) Operationalizing the 2014 ACC/AHA guidelines for valvular heart disease. J Am Coll Cardiol 67:2289–2294CrossRefPubMedGoogle Scholar
  5. 5.
    Moore M, Chen J (2016) The direct health-care burden of valvular heart disease: evidence from US national survey data. Clinicoecon Outcomes Res 8:613–627CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Hahn RT (2016) Transcathether valve replacement and valve repair: review of procedures and intraprocedural echocardiographic imaging. Circ Res 119:341–356CrossRefPubMedGoogle Scholar
  7. 7.
    Hamlin SA, Henry TS, Little BP et al (2014) Mapping the future of cardiac MR imaging: case-based review of T1 and T2 mapping techniques. Radiographics 34(6):1594–1611CrossRefPubMedGoogle Scholar
  8. 8.
    Mewton N, Liu CY, Croisille P et al (2011) Assessment of myocardial fibrosis with cardiovascular magnetic resonance. J Am Coll Cardiol 57:891–903CrossRefPubMedGoogle Scholar
  9. 9.
    Weidemann F, Herrmann S, Störk S et al (2009) Impact of myocardial fibrosis in patients with symptomatic severe aortic stenosis. Circulation 120:577–584CrossRefPubMedGoogle Scholar
  10. 10.
    Jellis C, Martin J, Narula J et al (2010) Assessment of nonischemic myocardial fibrosis. J Am Coll Cardiol 56:89–97CrossRefPubMedGoogle Scholar
  11. 11.
    Miller CA, Naish JH, Bishop P et al (2013) Comprehensive validation of cardiovascular magnetic resonance techniques for the assessment of myocardial extracellular volume. Circ Cardiovasc Imaging 6:373–383CrossRefPubMedGoogle Scholar
  12. 12.
    Uretsky S, Gillam L, Lang R et al (2015) Discordance between echocardiography and MRI in the assessment of mitral regurgitation severity: A prospective multicenter trial. J Am Coll Cardiol 65:1078–1088CrossRefPubMedGoogle Scholar
  13. 13.
    Nishimura RA, Otto CM, Bonow RO et al (2014) 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Thorac Cardiovasc Surg 148:e1–e132CrossRefPubMedGoogle Scholar
  14. 14.
    Vohra J, Sathe S, Warren R et al (1993) Malignant ventricular arrhythmias in patients with mitral valve prolapse and mild mitral regurgitation. Pacing Clin Electrophysiol 16:387–393CrossRefPubMedGoogle Scholar
  15. 15.
    Niu Z, Chan V, Mesana T, Ruel M (2016) The evolution of mitral valve prolapse: Insights from the Framingham Heart Study. J Thorac Dis 8:E827–E828CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Bui AH, Roujol S, Foppa M et al (2017) Diffuse myocardial fibrosis in patients with mitral valve prolapse and ventricular arrhythmia. Heart 103(3):204–209CrossRefPubMedGoogle Scholar
  17. 17.
    Narayanan K, Uy-evanado A, Teodorescu C et al (2016) Mitral valve prolapse and sudden cardiac arrest in the community. Heart Rhythm 13:498–503CrossRefPubMedGoogle Scholar
  18. 18.
    Lown B, Wolf M (1971) Approaches to sudden death from coronary heart disease. Circulation 44:130–142CrossRefPubMedGoogle Scholar
  19. 19.
    Kon MWS, Myerson SG, Moat NE, Pennell DJ (2004) Quantification of regurgitant fraction in mitral regurgitation by cardiovascular magnetic resonance: comparison of techniques. J Heart Valve Dis 13:600–607PubMedGoogle Scholar
  20. 20.
    Gelfand EV, Hughes S, Hauser TH et al (2006) Severity of mitral and aortic regurgitation as assessed by cardiovascular magnetic resonance: optimizing correlation with Doppler echocardiography. J Cardiovasc Magn Reson 8(3):503–507CrossRefPubMedGoogle Scholar
  21. 21.
    Cerqueira MD, Weissman NJ, Dilsizian V et al (2002) Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart. A statement for healthcare professionals from the Cardiac Imaging Committee of the Council on Clinical Cardiology of the American Heart Association. Int J Cardiovasc Imaging 18(1):539–542Google Scholar
  22. 22.
    Treibel TA, Fontana M, Maestrini V et al (2016) Automatic measurement of the myocardial interstitium: synthetic extracellular volume quantification without hematocrit sampling. JACC Cardiovasc Imaging 9:54–63CrossRefPubMedGoogle Scholar
  23. 23.
    Ugander M, Oki AJ, Hsu LY et al (2012) Extracellular volume imaging by magnetic resonance imaging provides insights into overt and sub-clinical myocardial pathology. Eur Heart J 33:1268–1278CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Van De Heyning CM, Magne J, Piérard LA et al (2014) Late gadolinium enhancement CMR in primary mitral regurgitation. Eur J Clin Invest 44(9):840–847CrossRefGoogle Scholar
  25. 25.
    Marra MP, Basso C, De Lazzari M et al (2016) Morphofunctional abnormalities of mitral annulus and arrhythmic mitral valve prolapse. Circ Cardiovasc Imaging 9:1–10Google Scholar
  26. 26.
    Sheppard MN, Steriotis AK, Sharma S (2016) Letter by Sheppard at al regarding article "Arrhythmic mitral valve prolapse and sudden cardiac death". Circulation 133:e458CrossRefPubMedGoogle Scholar
  27. 27.
    Spartalis M, Tzatzaki E, Spartalis E et al (2017) Mitral valve prolapse: an underestimated cause of sudden cardiac death - a current review of the literature. J Thorac Dis 9:5390–5398CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Fujita N, Chazouilleres AF, Hartiala JJ et al (1994) Quantification of mitral regurgitation by velocity-encoded cine nuclear magnetic resonance imaging. J Am Coll Cardiol 23:951–958Google Scholar
  29. 29.
    Kizilbash AM, Hundley WG, Willett DL et al (1998) Comparison of quantitative Doppler with magnetic resonance imaging for assessment of the severity of mitral regurgitation. Am J Cardiol 81:792–795CrossRefPubMedGoogle Scholar
  30. 30.
    Lopez-Mattei JC, Shah DJ (2013) The role of cardiac magnetic resonance in valvular heart disease. Methodist Debakey Cardiovasc J 9:142–148CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Edwards NC, Moody WE, Yuan M et al (2014) Quantification of left ventricular interstitial fibrosis in asymptomatic chronic primary degenerative mitral regurgitation. Circ Cardiovasc Imaging 7(6):946–953CrossRefPubMedGoogle Scholar

Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  • Silvia Pradella
    • 1
  • Giulia Grazzini
    • 2
  • Marta Brandani
    • 2
  • Linda Calistri
    • 2
  • Cosimo Nardi
    • 2
  • Fabio Mori
    • 3
  • Vittorio Miele
    • 1
  • Stefano Colagrande
    • 2
  1. 1.Department of RadiologyCareggi University HospitalFlorenceItaly
  2. 2.Department of Experimental and Clinical Biomedical SciencesUniversity of Florence – Careggi University HospitalFlorenceItaly
  3. 3.Department of CardiologyCareggi University HospitalFlorenceItaly

Personalised recommendations