Cardiovascular Magnetic Resonance Characterization of Mitral Valve Prolapse

Han, Yuchi; Peters, Dana C.; Salton, Carol J; Bzymek, Dorota; Nezafat, Reza; Goddu, Beth; Kissinger, Kraig V.; Zimetbaum, Peter; Manning, Warren J.; Yeon, Susan B.

doi:10.1016/j.jcmg.2008.01.013

Cited by 212 publications

(171 citation statements)

References 35 publications

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“…Thus, a regional LV papillary muscle and inferobasal fibrosis was found to characterize both MVP victims with SCD as well as MVP patients with complex ventricular ectopy; presenting a novel specific risk factor for SCD among MVP patients. Notably, similar findings on CMR or histopathology have been previously reported [12,13]. Given the correlation between the source of ventricular ectopy and the areas of cardiac fibrosis, a mechanical stretch hypothesis has been raised [14], by which a mechanical stretch of the myocardium in these specific areas results from the prolapsing MV leaflets.…”

supporting

confidence: 64%

Sudden Cardiac Death in Mitral Valve Prolapse: Are we ready for Risk Stratification?

M¹,

Wolak²

2017

JCCR

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supporting

confidence: 64%

Sudden Cardiac Death in Mitral Valve Prolapse: Are we ready for Risk Stratification?

M¹,

Wolak²

2017

JCCR

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“…Хотя изменения систолической и диастолической функций может быть обусловлено развитием фиброза миокарда ЛЖ, появление которого, как мы уже отме-чали, недавно было описано у симптомных пациентов с ПМК при проведении магнитно-резонансной томо-графии [24] у бессимптомных лиц молодого возраста, наиболее вероятной причиной выявленных нами изменений регионарной сократимости является нару-шение структуры и функции соединительной ткани.…”

Section: Discussionunclassified

Systemic Involvement of Connective Tissue and the Heart as Important Characteristics of Primary Mitral Valve Prolapse

Земцовский¹,

Малев²,

Реева³

2014

Russ J Cardiol

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Цель. Оценка системного вовлечения соединительной ткани (СВСТ) у бес-симптомных пациентов молодого возраста с ПМК без значимой митральной регургитации. Материал и методы. В исследование было включено 78 пациентов с пролап-сом митрального клапана (ПМК) (средний возраст -19,7±1,6 лет; 72% юноши). Контрольную группу составили 80 здоровых лиц сопоставимого возраста и пола. Проведено фенотипическое обследование лиц с ПМК и конт рольной группы, и ЭхоКГ-исследование для выявления малых аномалий серд ца (МАС). Продольная деформация и скорость деформации миокарда оценивались с помощью методики spackle tracking (Vivid 7 Dim, EchoPAC'06, GE). Результаты. Было выделено два кластера пациентов с ПМК. В 1 кластере (17 человек, 28% от всей группы ПМК) наблюдалось значимое снижение про-дольной систолической деформации по сравнению с контрольной группой и вторым кластером (61 человек, 72%). Глобальный стрейн у лиц 2 кластера достоверно не отличался от контрольной группы. ЭхоКГ-исследование выя-вило недостоверное увеличение среднего числа баллов СВСТ в 1 кластере и высоко достоверное увеличение числа МАС в этой группе обследованных. Заключение. Оценка деформации миокарда позволила нам выявить у части молодых бессимптомных пациентов с ПМК признаки кардиомиопатии (КМП). Увеличение числа МАС в группе лиц с первичным ПМК и КМП позволяет рас-сматривать пролапсы других клапанов, расширение магистральных сосудов, базальные и толстые хорды ЛЖ в качестве признаков ВСТС при первичном ПМК. Наличие большого числа этих МАС при первичном ПМК может указывать на изменение экстрацеллюлярного матрикса сердца, способное стать причи-ной развития КМП при первичном ПМК. Российский кардиологический журнал 2014, 9 (113): 54-60Ключевые слова: пролапс митрального клапана, функция левого желудочка, малые аномалии сердца, системное вовлечение соединительной ткани. SYSTEMIC INVOLVEMENT OF CONNECTIVE TISSUE AND THE HEART AS IMPORTANT CHARACTERISTICS OF PRIMARY MITRAL VALVE PROLAPSEZemtsovsky E. V. Aim. To evaluate systemic involvement of connective tissue (SICT) in young adults with mitral valve prolapse (MVP) without significant mitral regurgitation (MR). Material and methods. We studied 78 asymptomatic young subjects (mean age 19,7±1,6, 72% male) with MVP in comparison with 80 sex-and age-matched healthy subjects. We performed phenotypic examination of MVP patients and control group subjects, and echocardiographic study to identify the minor heart anomalies. Longitudinal strain and strain rate (SR) were determined using spackle tracking (Vivid 7 Dimension GE, EchoPAC'08). Results. We identified two clusters of patients with MVP. In the first cluster (17 subjects, 28% of the MVP group) a significant reduction of longitudinal systolic strain observed comparing to the control group and the second cluster (61 subjects, 72%). Global strain in the second cluster did not differ significantly from the control group. Echocardiographic study showed nonsignificant increase in the average number of SICT points in the first cluster and highly significant increase of the...

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“…Localization of valve dysfunction is important for surgical planning, as some mitral valve abnormalities are less amenable to successful mitral valve repair (e.g., repair is less durable for extensive anterior leaflet disease) (42). Among a cohort of 25 patients with MVP, Han et al reported cine-CMR assessment of leaflet displacement to provide high sensitivity (100%) and specificity (100%) compared to the reference standard of transthoracic echo (43). Among a cohort of 27 patients with MVP, Gabriel et al reported that cine-CMR accurately determined presence or absence of involvement of each leaflet in 98% of cases compared to the reference of transthoracic echo; in a subset of patients (n=10) who underwent transesophageal echo or surgery, accuracy of cine-CMR was 82% (44).…”

Section: Primary Mrmentioning

confidence: 99%

“…Beyond mitral valve structure and function, CMR can be used to assess altered myocardial tissue properties associated with MVP. For example, Han et al used DE-CMR to assess papillary muscle fibrosis among a pilot cohort of 16 patients with MVP (43). The authors reported papillary fibrosis to be present in over half (10/16) patients with MVP in whom it was associated with increased ventricular ectopy, suggesting that this finding may be of prognostic significance (43).…”

Section: Primary Mrmentioning

confidence: 99%

“…For example, Han et al used DE-CMR to assess papillary muscle fibrosis among a pilot cohort of 16 patients with MVP (43). The authors reported papillary fibrosis to be present in over half (10/16) patients with MVP in whom it was associated with increased ventricular ectopy, suggesting that this finding may be of prognostic significance (43). Further studies are warranted to test prevalence of MVP-associated papillary fibrosis among larger (e.g., multicenter) cohorts, as well as to test the predictive value of this finding for stratifying actual clinical outcomes among patients with MVP.…”

Section: Primary Mrmentioning

confidence: 99%

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Utility of cardiac magnetic resonance for evaluation of mitral regurgitation prior to mitral valve surgery

et al. 2017

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Mitral regurgitation (MR) is a common cause of morbidity worldwide and an accepted indication for interventional therapies which aim to reduce or resolve adverse clinical outcomes associated with MR.Cardiac magnetic resonance (CMR) provides highly accurate means of assessing MR, including a variety of approaches that can measure MR based on quantitative flow. Additionally, CMR is widely accepted as a reference standard for cardiac chamber quantification, enabling reliable detection of subtle changes in cardiac chamber size and function so as to guide decision-making regarding timing of mitral valve directed therapies. Beyond geometric imaging, CMR enables tissue characterization of ischemia and infarction in the left ventricular (LV) myocardium as well as within the mitral valve apparatus, thus enabling identification of structural substrates for MR. This review provides an overview of established and emerging CMR approaches to measure valvular regurgitation, including relative utility of different approaches for patients with primary or secondary MR. Clinical outcomes studies are discussed with focus on data demonstrating advantages of CMR for guiding diagnosis, risk stratification, and management of patients with known or suspected MR. Comparative data is reviewed with focus on diagnostic performance of CMR in comparison to conventional assessment via echocardiography (echo). Emerging literature is reviewed concerning potential new approaches that utilize CMR tissue characterization to guide clinical decision-making in order to improve therapeutic outcomes and clinical prognosis for patients with MR. J Thorac Dis 2017;9(Suppl 4):S246-S256 jtd.amegroups.com pre-operative morbidity and decreases procedural efficacy (9,10), possibly due to impact of LV or left atrial (LA) dilation on mitral apparatus geometry or wall stress (11-13). Accordingly, consensus guidelines recommend surgery for patients with severe primary MR if symptoms are present or, in the case of asymptomatic individuals, if LV dysfunction (ejection fraction <60%) or chamber dilation (end-systolic diameter ≥40 mm) is present (14). Echocardiography (echo) is widely used to guide decision-making concerning timing of interventional therapies for MR (14). However, echo can be suboptimal for this purpose, as image quality can vary (15), chamber quantification is typically predicated on 2-dimensional (2D) geometric assumptions [rather than 3-dimensional (3D) imaging] (16), and MR quantification can be challenging in the context of regurgitant jet eccentricity (17). These limitations may explain recent data suggesting lack of correlation between pre-operative echo-quantified MR severity and LV reverse remodeling after mitral valve surgery (18). Knowledge gaps regarding predictors of procedural success limit the ability to optimize decision-making for patients with MR.Cardiac magnetic resonance (CMR) can assess MR as well as its predisposing risk factors. A variety of CMR pulse sequences can be used for MR assessment ( Table 1). Phase velocity en...

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Cardiovascular Magnetic Resonance Characterization of Mitral Valve Prolapse

Cited by 212 publications

References 35 publications

Sudden Cardiac Death in Mitral Valve Prolapse: Are we ready for Risk Stratification?

Sudden Cardiac Death in Mitral Valve Prolapse: Are we ready for Risk Stratification?

Systemic Involvement of Connective Tissue and the Heart as Important Characteristics of Primary Mitral Valve Prolapse

Utility of cardiac magnetic resonance for evaluation of mitral regurgitation prior to mitral valve surgery

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