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

  • Cardiac
  • Published:
European Radiology Aims and scope Submit manuscript

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.

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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

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Funding

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

Author information

Authors and Affiliations

  1. Department of Radiology, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy

    Silvia Pradella & Vittorio Miele

  2. Department of Experimental and Clinical Biomedical Sciences, University of Florence – Careggi University Hospital, Radiodiagnostic Unit n. 2, Largo Brambilla 3, 50134, Florence, Italy

    Giulia Grazzini, Marta Brandani, Linda Calistri, Cosimo Nardi & Stefano Colagrande

  3. Department of Cardiology, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy

    Fabio Mori

Authors
  1. Silvia Pradella
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  2. Giulia Grazzini
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  4. Linda Calistri
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  5. Cosimo Nardi
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  6. Fabio Mori
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  7. Vittorio Miele
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  8. Stefano Colagrande
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Corresponding author

Correspondence to Silvia Pradella.

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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

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Pradella, S., Grazzini, G., Brandani, M. et al. Cardiac magnetic resonance in patients with mitral valve prolapse: Focus on late gadolinium enhancement and T1 mapping. Eur Radiol 29, 1546–1554 (2019). https://doi.org/10.1007/s00330-018-5634-5

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  • DOI: https://doi.org/10.1007/s00330-018-5634-5

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