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

Gatti, Marco; Palmisano, Anna; Esposito, Antonio; Fiore, Stefano; Monti, Caterina Beatrice; Andreis, Alessandro; Pistelli, Lorenzo; Vergara, Pasquale; Bergamasco, Laura; Giustetto, Carla; Cobelli, Francesco De; Fonio, Paolo; Faletti, Riccardo

doi:10.1007/s00330-021-07876-z

Cited by 13 publications

(8 citation statements)

References 31 publications

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“…Furthermore, cine CMR images have substantially lower spatial and temporal resolution than STE [ 24 , 25 ]. These differences might explain why, unlike findings from studies using speckle tracking echocardiography [ 26 ], but consistent with prior findings using CMR-FT [ 11 , 27 ] we did not observe differences in GLS between MVP patients and controls, even in the presence of significant mitral regurgitation.…”

Section: Discussionsupporting

confidence: 91%

Additional value of cardiac magnetic resonance feature tracking parameters for the evaluation of the arrhythmic risk in patients with mitral valve prolapse

Guglielmo

Arangalage

Bonino

et al. 2023

Journal of Cardiovascular Magnetic Resonance

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Objectives The identification of patients with mitral valve prolapse (MVP) presenting high arrhythmic risk remains challenging. Cardiovascular Magnetic Resonance (CMR) feature tracking (FT) may improve risk stratification. We analyzed the role of CMR-FT parameters in relation to the incidence of complex ventricular arrhythmias (cVA) in patients with MVP and mitral annular disjunction (MAD). Methods 42 patients with MVP and MAD who underwent 1.5 T CMR were classified as MAD-cVA (n = 23, 55%) in case of cVA diagnosed on a 24-h Holter monitoring and as MAD-noVA in the absence of cVA (n = 19, 45%). MAD length, late gadolinium enhancement (LGE), basal segments myocardial extracellular volume (ECV) and CMR-FT were assessed. Results LGE was more frequent in the MAD-cVA group in comparison with the MAD-noVA group (78% vs 42%, p = 0.002) while no difference was observed in terms of basal ECV. Global longitudinal strain (GLS) was reduced in MAD-cVA compared to MAD-noVA (− 18.2% ± 4.6% vs − 25.1% ± 3.1%, p = 0.004) as well as global circumferential strain (GCS) at the mid-ventricular level (− 17.5% ± 4.7% vs − 21.6% ± 3.1%, p = 0.041). Univariate analysis identified as predictors of the incidence of cVA: GCS, circumferential strain (CS) in the basal and mid infero-lateral wall, GLS, regional longitudinal strain (LS) in the basal and mid-ventricular inferolateral wall. Reduced GLS [Odd ratio (OR):1.56 (confidence interval (CI) 95%: 1.45–2.47; p < 0.001)] and regional LS in the basal inferolateral wall [OR: 1.62 (CI 95%: 1.22–2.13; p < 0.001)] remained independent prognostic factors in multivariate analysis. Conclusion In patients with MVP and MAD, CMR-FT parameters are correlated with the incidence of cVA and may be of interest in arrhythmic risk stratification.

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Section: Discussionsupporting

confidence: 91%

Additional value of cardiac magnetic resonance feature tracking parameters for the evaluation of the arrhythmic risk in patients with mitral valve prolapse

Guglielmo

Arangalage

Bonino

et al. 2023

Journal of Cardiovascular Magnetic Resonance

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“…After removing duplicates and irrelevant articles, 65 studies were screened. Ultimately, 12 studies (with data for 1464 participants), including three case‒control studies [ 5 , 9 , 10 ], six cross‐sectional studies [ 1 , 2 , 4 , 6 , 11 , 12 ], and three cohort studies [ 13 , 14 , 15 ], were eligible. Among the 53 excluded studies, 16 were case reports, 17 were reviews, 12 lacked necessary data for meta‐analysis, five did not report any arrhythmias, and three lacked full text.…”

Section: Resultsmentioning

confidence: 99%

“…Late gadolinium enhancement (LGE) can be detected by CMR and is usually associated with the papillary muscle and the subbasal segment of the left ventricle adjacent to the prolapsed mitral valvulae [ 5 ]. The development of malignant ventricular arrhythmia (VA) seems to be related to endocardium stimulation with extended tendon [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

The Association Between Late Gadolinium Enhancement by Cardiac Magnetic Resonance and Ventricular Arrhythmia in Patients With Mitral Valve Prolapse: A Systematic Review and Meta‐Analysis

Tang,

Fan

2024

Clinical Cardiology

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IntroductionMalignant ventricular arrhythmia (VA) and sudden cardiac death (SCD) have been reported in patients with mitral valve prolapse (MVP); however, effective risk stratification methods are still lacking. Myocardial fibrosis is thought to play an important role in the development of VA; however, observational studies have produced contradictory findings regarding the relationship between VA and late gadolinium enhancement (LGE) in MVP patients. The aim of this meta‐analysis and systematic review of observational studies was to investigate the association between left ventricular LGE and VA in patients with MVP.MethodsWe searched the PubMed, Embase, and Web of Science databases from 1993 to 2023 to identify case–control, cross‐sectional, and cohort studies that compared the incidence of VA in patients with MVP who had left ventricular LGE and those without left ventricular LGE.ResultsA total of 1464 subjects with MVP from 12 observational studies met the eligibility criteria. Among them, VA episodes were reported in 221 individuals (15.1%). Meta‐analysis demonstrated that the presence of left ventricular LGE was significantly associated with an increased risk of VA (pooled risk ratio 2.96, 95% CI: 2.26−3.88, p for heterogeneity = 0.07, I2 = 40%). However, a meta‐regression analysis of the prevalence of mitral regurgitation (MR) showed that the severity of MR did not significantly affect the association between the occurrence of LGE and VA (p = 0.079).ConclusionThe detection of LGE could be helpful for stratifying the risk of VA in patients with MVP.

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“…The copyright holder for this preprint this version posted June 6, 2023. ; https://doi.org/10.1101/2023.06.05.23290557 doi: medRxiv preprint disjunction of any extent (6,11,18). However, in some rare studies, also larger cut-offs can be found, such as 2mm (19) and 5mm (20).…”

Section: Mad In Unknown-cause Ohcamentioning

confidence: 99%

Mitral Annular Disjunction in Out-of-Hospital Cardiac Arrest Patients – a Retrospective Cardiac MRI Study

Troger,

Klug,

Poskaite

et al. 2023

Preprint

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Background: Mitral annular disjunction (MAD), defined as defective attachment of the mitral annulus to the ventricular myocardium, has recently been linked to malignant arrhythmias. However, its role and prognostic significance in patients requiring cardio-pulmonary resuscitation (CPR) remains unknown. This retrospective analysis aimed to describe prevalence and significance of MAD by cardiac magnetic resonance (CMR) imaging, in out-of-hospital cardiac arrest (OHCA) patients. Methods: Eighty-six patients with OHCA and a CMR scan 5 days after CPR (interquartile range (IQR): 49 days before – 9 days after) were consecutively enrolled. MAD was defined as disjunction-extent ≥1mm in CMR long-axis cine-images. Medical records were screened for laboratory parameters, comorbidities and prior arrhythmias. Results: In 34 patients (40%), no underlying cause for OHCA was found during hospitalization despite profound diagnostics. Unknown-cause OHCA patients showed a higher prevalence of MAD compared to definite-cause patients (56% vs. 10%, p<0.001) and had a MAD-extent of 6.3mm (IQR: 4.4-10.3); moreover, these patients were significantly younger (43 years vs. 61 years, p<0.001), more often female (74% vs. 21%, p<0.001) and had fewer comorbidities (hypertension, hypercholesterolemia, coronary artery disease, all p<0.005). By logistic regression analysis, presence of MAD remained significantly associated with OHCA of unknown cause (odds ratio: 8.49, 95% confidence interval: 2.37-30.41, p=0.001) after adjustment for age, presence of hypertension and hypercholesterolemia. Conclusions: MAD is rather common in OHCA patients without definitive aetiology undergoing CMR. Presence of MAD remains independently associated to OHCA without identifiable trigger. Further research is needed to understand the exact role of MAD in OHCA patients.

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

Cited by 13 publications

References 31 publications

Additional value of cardiac magnetic resonance feature tracking parameters for the evaluation of the arrhythmic risk in patients with mitral valve prolapse

Additional value of cardiac magnetic resonance feature tracking parameters for the evaluation of the arrhythmic risk in patients with mitral valve prolapse

The Association Between Late Gadolinium Enhancement by Cardiac Magnetic Resonance and Ventricular Arrhythmia in Patients With Mitral Valve Prolapse: A Systematic Review and Meta‐Analysis

Mitral Annular Disjunction in Out-of-Hospital Cardiac Arrest Patients – a Retrospective Cardiac MRI Study

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