Abstract 15795: Prevalence and Characteristics of Left Ventricular Fibrosis in Patients With Mitral Valve Prolapse
Introduction: Studies have suggested a link between mitral valve prolapse (MVP) and arrhythmia/sudden cardiac arrest. LV fibrosis is potentially an arrhythmia substrate. Late gadolinium enhancement (LGE) CMR is established for detection of LV fibrosis. We evaluated for LV fibrosis in MVP patients using LGE-CMR.
Method: Consecutive patients with primary MR undergoing CMR were enrolled, and classified as MVP or non-MVP etiology. We excluded secondary MR and confounding etiologies of LV fibrosis (e.g. CAD, significant LVH). All underwent cine-CMR to assess cardiac morphology/function, phase contrast CMR to quantify MR, and LGE-CMR 10 minutes after gadolinium to identify LV fibrosis.
Result: Among 356 patients with primary MR, MVP was present in 177 (49.7%). Overall, LV fibrosis occurred in 83 patients (23.3%) in which mid-wall striae was the most common LGE pattern (54.2%), mean LGE burden 2.2% ± 0.9% of LV. LGE was more prevalent in patients with MVP (37.9% vs. 8.9%, p < 0.001), most common in the basal inferolateral wall (31.1%). Although prevalence of LGE increased with MR severity, it was more prevalent in MVP patients for any given severity of MR (figure 1). After adjusting for clinical and imaging variables including severity of MR, MVP was associated with finding of LGE (OR = 4.5, 95% CI of 2.3-8.7, p < 0.001) and LGE in the basal-mid inferolateral and basal inferior wall (OR of 39.4, 95% CI of 9.0-172.6, p < 0.001).
Conclusion: In primary MR, LV fibrosis, a potential substrate for arrhythmias, was more prevalent in MVP patients irrespective of severity of MR or other clinical/imaging variables. These findings suggest a unique pathophysiology of MVP beyond valvular regurgitation alone.
Author Disclosures: D. Kitkungvan: None. F. Nabi: None. M. Quinones: None. J. Xu: None. G. Lawrie: None. S.H. Little: None. W. Zoghbi: None. D.J. Shah: None.
- © 2015 by American Heart Association, Inc.