Myocardial extracellular volume by T1 mapping: a new marker of arrhythmia in mitral valve prolapse

被引:47
作者
Pavon, Anna Giulia [1 ,2 ,4 ]
Arangalage, Dimitri [1 ]
Pascale, Patrizio [1 ,3 ]
Hugelshofer, Sarah [1 ,2 ]
Rutz, Tobias [1 ,2 ,3 ]
Porretta, Alessandra Pia [1 ]
Le Bloa, Mathieu [1 ]
Muller, Olivier [1 ,3 ]
Pruvot, Etienne [1 ,3 ]
Schwitter, Juerg [1 ,2 ,3 ]
Monney, Pierre [1 ,2 ,3 ]
机构
[1] Lausanne Univ Hosp CHUV, Dept Cardiol, Rue Bugnon 46, CH-1011 Lausanne, Switzerland
[2] Lausanne Univ Hosp, Ctr Cardiac Magnet Resonance CHUV CRMC, Lausanne, Switzerland
[3] Univ Lausanne UniL, Lausanne, Switzerland
[4] Fdn Cardioctr Ticino, Div Cardiol, Via Tesserete 48, CH-6900 Lugano, Switzerland
关键词
Mitral valve prolapse; Cardiovascular magnetic resonance; Mitral annular disjunction; Interstitial fibrosis; CARDIOVASCULAR MAGNETIC-RESONANCE; CARDIAC-ARREST; FIBROSIS; QUANTIFICATION; DEATH; SCAR; DISJUNCTION; EVENTS; HEART; RISK;
D O I
10.1186/s12968-021-00797-2
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objectives We aimed to evaluate the relationship between mitral annular disjunction (MAD) severity and myocardial interstitial fibrosis at the left ventricular (LV) base in patients with mitral valve prolapse (MVP), and to assess the association between severity of interstitial fibrosis and the occurrence of ventricular arrhythmic events. Background In MVP, MAD has been associated with myocardial replacement fibrosis and arrhythmia, but the importance of interstitial fibrosis remains unknown. Methods In this retrospective study, 30 patients with MVP and MAD (MVP-MAD) underwent cardiovascular magnetic resonance (CMR) with assessment of MAD length, late gadolinium enhancement (LGE), and basal segments myocardial extracellular volume (ECVsyn). The control group included 14 patients with mitral regurgitation (MR) but no MAD (MR-NoMAD) and 10 patients with normal CMR (NoMR-NoMAD). Fifteen MVP-MAD patients underwent 24 h-Holter monitoring. Results LGE was observed in 47% of MVP-MAD patients and was absent in all controls. ECVsyn was higher in MVP-MAD (30 +/- 3% vs 24 +/- 3% MR-NoMAD, p < 0.001 and vs 24 +/- 2% NoMR-NoMAD, p < 0.001), even in MVP-MAD patients without LGE (29 +/- 3% vs 24 +/- 3%, p < 0.001 and vs 24 +/- 2%, p < 0.001, respectively). MAD length correlated with ECVsyn (rho = 0.61, p < 0.001), but not with LGE extent. Four patients had history of out-of-hospital cardiac arrest; LGE and ECVsyn were equally performant to identify those high-risk patients, area under the receiver operating characteristic (ROC) curve 0.81 vs 0.83, p = 0.84). Among patients with Holter, 87% had complex ventricular arrhythmia. ECVsyn was above the cut-off value in all while only 53% had LGE. Conclusion Increase in ECVsyn, a marker of interstitial fibrosis, occurs in MVP-MAD even in the absence of LGE, and was correlated with MAD length and increased risk of out-of-hospital cardiac arrest. ECV should be includedin the CMR examination of MVP patients in an effort to better assess fibrous remodelling as it may provide additional value beyond the assessment of LGE in the arrhythmic risk stratification.
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页数:13
相关论文
共 43 条
[1]   Scar Characterization to Predict Life-Threatening Arrhythmic Events and Sudden Cardiac Death in Patients With Cardiac Resynchronization Therapy The GAUDI-CRT Study [J].
Acosta, Juan ;
Fernandez-Armenta, Juan ;
Borras, Roger ;
Anguera, Ignasi ;
Bisbal, Felipe ;
Marti-Almor, Julio ;
Tolosana, Jose M. ;
Penela, Diego ;
Andreu, David ;
Soto-Iglesias, David ;
Evertz, Reinder ;
Matiello, Maria ;
Alonso, Concepcion ;
Villuendas, Roger ;
de Caralt, Teresa M. ;
Perea, Rosario J. ;
Ortiz, Jose T. ;
Bosch, Xavier ;
Serra, Luis ;
Planes, Xavier ;
Greiser, Andreas ;
Ekinci, Okan ;
Lasalvia, Luis ;
Mont, Lluis ;
Berruezo, Antonio .
JACC-CARDIOVASCULAR IMAGING, 2018, 11 (04) :561-572
[2]   Arrhythmogenic Potential of Border Zone After Myocardial Infarction Scar Is More Than Just a Healed Wound... [J].
Arbustini, Eloisa ;
Kramer, Christopher M. ;
Narula, Jagat .
JACC-CARDIOVASCULAR IMAGING, 2018, 11 (04) :573-576
[3]   Arrhythmic Mitral Valve Prolapse and Sudden Cardiac Death [J].
Basso, Cristina ;
Marra, Martina Perazzolo ;
Rizzo, Stefania ;
De lazzari, Manuel ;
Giorgi, Benedetta ;
Cipriani, Alberto ;
Frigo, Anna Chiara ;
Rigato, Ilaria ;
Migliore, Federico ;
Pilichou, Kalliopi ;
Bertaglia, Emanuele ;
Cacciavillani, Luisa ;
Bauce, Barbara ;
Corrado, Domenico ;
Thiene, Gaetano ;
Iliceto, Sabino .
CIRCULATION, 2015, 132 (07) :556-566
[4]   Imaging and Impact of Myocardial Fibrosis in Aortic Stenosis [J].
Bing, Rong ;
Cavalcante, Joao L. ;
Everett, Russell J. ;
Clavel, Marie-Annick ;
Newby, David E. ;
Dweck, Marc R. .
JACC-CARDIOVASCULAR IMAGING, 2019, 12 (02) :283-296
[5]   MITRAL-VALVE PROLAPSE - CARDIAC-ARREST WITH LONG-TERM SURVIVAL [J].
BOUDOULAS, H ;
SCHAAL, SF ;
STANG, JM ;
FONTANA, ME ;
KOLIBASH, AJ ;
WOOLEY, CF .
INTERNATIONAL JOURNAL OF CARDIOLOGY, 1990, 26 (01) :37-44
[6]   Diffuse myocardial fibrosis in patients with mitral valve prolapse and ventricular arrhythmia [J].
Bui, An H. ;
Roujol, Sebastien ;
Foppa, Murilo ;
Kissinger, Kraig V. ;
Goddu, Beth ;
Hauser, Thomas H. ;
Zimetbaum, Peter J. ;
Ngo, Long H. ;
Manning, Warren J. ;
Nezafat, Reza ;
Delling, Francesca N. .
HEART, 2017, 103 (03) :204-209
[7]   Performance of Synthetic Extracellular Volume Fraction in Different Cardiac Phenotypes From a Prospective Cohort of Patients Referred for Cardiac Magnetic Resonance [J].
Censi, Stefano ;
Cimaglia, Paolo ;
Barbieri, Alessandra ;
Naldi, Monica ;
Ruggerini, Sara ;
Brogneri, Simona ;
Tonet, Elisabetta ;
Rapezzi, Claudio ;
Squeri, Angelo .
JOURNAL OF MAGNETIC RESONANCE IMAGING, 2021, 54 (02) :429-439
[8]  
Cerqueira MD, 2002, INT J CARDIOVAS IMAG, V18, P539
[9]   Prognostic Value of Quantitative Contrast-Enhanced Cardiovascular Magnetic Resonance for the Evaluation of Sudden Death Risk in Patients With Hypertrophic Cardiomyopathy [J].
Chan, Raymond H. ;
Maron, Barry J. ;
Olivotto, Iacopo ;
Pencina, Michael J. ;
Assenza, Gabriele Egidy ;
Haas, Tammy ;
Lesser, John R. ;
Gruner, Christiane ;
Crean, Andrew M. ;
Rakowski, Harry ;
Udelson, James E. ;
Rowin, Ethan ;
Lombardi, Massimo ;
Cecchi, Franco ;
Tomberli, Benedetta ;
Spirito, Paolo ;
Formisano, Francesco ;
Biagini, Elena ;
Rapezzi, Claudio ;
De Cecco, Carlo Nicola ;
Autore, Camillo ;
Cook, E. Francis ;
Hong, Susie N. ;
Gibson, C. Michael ;
Manning, Warren J. ;
Appelbaum, Evan ;
Maron, Martin S. .
CIRCULATION, 2014, 130 (06) :484-495
[10]   SLOW CONDUCTION IN THE INFARCTED HUMAN HEART - ZIGZAG COURSE OF ACTIVATION [J].
DEBAKKER, JMT ;
VANCAPELLE, FJL ;
JANSE, MJ ;
TASSERON, S ;
VERMEULEN, JT ;
DEJONGE, N ;
LAHPOR, JR .
CIRCULATION, 1993, 88 (03) :915-926