Unveiling early cardiac remodeling in mitral valve prolapse with non-significant mitral regurgitation: a comprehensive CMR study. (RF_TH_213)

Thursday, January 30, 2025

1:50 PM – 2:00 PM East Coast USA Time

Location: Blue Room PreFunction

Presenting Author(s)

LT

Lara Tondi, MD

Cardiologist
University of Milan, Italy

Primary Author(s)

LT

Lara Tondi, MD

Cardiologist
University of Milan, Italy

Co-Author(s)

SM

Silvia Mantua, MD

Radiology Resident
Università degli Studi di Parma, Italy
GG

Gianluigi Guida, MD

Medical Doctor, Cardiologist
IRCCS Policlinico San Donato, Italy
EG

Eleonora Gnan, MD

Cardiology Resident
Università degli Studi di Milano, Italy
FG

Francesco Giangiacomi, MD

Cardiology Resident
Università degli Studi di Milano, Italy
AC

Antonia Camporeale, MD, PhD

Cardiologist
IRCCS Policlinico San Donato, Italy
AA

Andrea Attanasio, MD

Cardiologist
IRCCS Policlinico San Donato, Italy
GD

Giandomenico Disabato, MD

Cardiologist
IRCCS Policlinico San Donato, Italy
GC

Gianpaolo Carrafiello, MD

Professor of Radiology
Università degli Studi di Milano, Italy
PS

Pietro Spagnolo, MD

Medical Doctor, Radiologist
IRCCS Policlinico San Donato, Italy
ML

Massimo Lombardi, MD

Head of CMR Unit
IRCCS Policlinico San Donato, Italy

Background: Mitral valve prolapse (MVP) prevalence ranges from 2% to 3% in the general population and is traditionally considered one of the most common valvular heart diseases. However, recent evidence has highlighted the presence of myocardial structural alterations and cardiac remodelling of the left chambers disproportionate to the entity of mitral regurgitation (MR). Cardiac magnetic resonance (CMR) is the gold standard for the assessment of ventricular volumes, and the CMR feature-tracking algorithm also allows for the evaluation of atrial function and volumes, with proven reproducibility. The aim of this study is to assess cardiac remodelling and LA function in MVP patients with non-significant MR through a comprehensive evaluation of morpho-functional parameters at CMR.

Methods: 87 MVP patients with non-significant MR and 20 healthy controls matched for age, sex, and body surface area, underwent CMR (Siemens Magnetom Aera 1.5 T) at IRCCS Policlinico San Donato (San Donato Milanese, Milan, Italy). The following CMR parameters were analyzed in cineSSFP sequences, and compared between the two groups: biventricular volumes and ejection fraction (EF), left ventricular (LV) mass, LV sphericity index, left atrial (LA) strain (reservoir, conduit, booster pump), LA volumes and LA EF, LA sphericity index, % of trabeculated LV mass and the ratio of non-compacted to compacted LV mass. In MVP patients, CMR assessment also included late gadolinium enhancement (LGE) sequences and phase-contrast images for MR quantification. Mitral annulus disjunction (MAD) was defined as a separation ≥ 1.0 mm between the left atrial wall - mitral valve leaflet junction and the basal LV wall during end-systole in 3ch view.

Results:

As compared to healthy controls, MVP patients showed biventricular and LA remodeling, with increased LV, RV and LA volumes, as well as higher LV and LA sphericity indexes, and more prominent LV trabeculations. CMR-FT analysis revealed lower LA strain for all phasic functions (reservoir, conduit and booster pump) and lower LA EF. Patients with MVP showed a higher prevalence and extent of MAD in comparison with healthy controls. LGE was detected in 48% of MVP patients, with a predominant location in the inferior and inferolateral basal walls. All results are reported in the Table and graphically resumed in the Figure.

Conclusion:

MVP patients with non-significant MR show cardiac remodelling, lower LA function and increased LV trabeculations compared to healthy controls. These findings suggest shifting the concept of MVP from isolated valvular heart disease towards a cardiomyopathy phenotype, entailing structural and functional myocardial alterations independently of MR-related volume overload.