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- Open Access
Cardiac magnetic resonance predictors of mitral regurgitation and papillary muscle fibrosis in mitral valve prolapse
https://doi.org/10.1186/1532-429X-12-S1-P281
© Delling et al; licensee BioMed Central Ltd. 2010
- Published: 21 January 2010
Keywords
- Cardiac Magnetic Resonance
- Mitral Regurgitation
- Late Gadolinium Enhancement
- Papillary Muscle
- Mitral Valve Prolapse
Introduction
Compared to extensive studies in echocardiography, cardiac magnetic resonance (CMR) predictors of mitral regurgitation (MR) in mitral valve prolapse (MVP) have yet to be defined. Characterization of the mitral valve may be important for prognosis of progression of MVP-related MR and facilitating surgical decision making. In addition, papillary muscle (PM) fibrosis has been observed in pathological studies of MVP and in vivo by late gadolinium enhancement (LGE) and attributed to PM "stretch" by displaced mitral valve leaflets.
Purpose
We aimed at evaluating the correlation between mitral valve characteristics and MVP-related MR, and in a subgroup of patients with LGE imaging, PM fibrosis.
Methods
Three-chamber view A) at end-systole with papillary muscle (PM) distance to anterior (PMA) and posterior (PMP) leaflet and to coaptation point (PMCP); anterior (AD) and posterior (PD) leaftet deplacement, annular dimension (Ann); B) in diastaasis with anterior (AT) and posterior (PT) leaflet thickness and C) length (AL, PL). D) short-axis view with PM LGE (arrow).
Results
By multivariate analysis, MR volume was correlated with posterior displacement (p = 0.002), anterior length (p < 0.001), and PM distance to coaptation point (p < 0.001), with a model adjusted R2 = 0.53. PM LGE (Figure 1D) was present in 30 patients (44%) and was associated with posterior leaflet thickness (p = 0.04) by simple linear regression, but not leaflet displacement or any other parameter.
Conclusion
Posterior leaflet displacement, anterior leaflet length, and PM distance to coaptation point are the best CMR valve determinants of MVP-related MR. PM fibrosis by LGE is related to posterior leaflet thickness, but not to leaflet displacement. These findings suggest that PM "stretch" may not always translate into PM fibrosis.
Authors’ Affiliations
Copyright
This article is published under license to BioMed Central Ltd.