Interstitial Fibrosis and Arrhythmic Mitral Valve Prolapse: Unravelling Sex-Based Differences.

IF 4.2 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS
Lionel Tastet, Shalini Dixit, Rohit Jhawar, Thuy Nguyen, Mohammad Al-Akchar, Rdcs Dwight Bibby, Farzin Arya, Luca Cristin, Shafkat Anwar, Satoshi Higuchi, Henry Hsia, Yoo Jin Lee, Francesca N Delling
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引用次数: 0

Abstract

Background: Interstitial fibrosis as quantified by cardiac magnetic resonance (CMR) has been demonstrated in arrhythmic mitral valve prolapse (AMVP), a condition with known female predominance. Prior studies of interstitial fibrosis in AMVP have only included cases with significant mitral regurgitation (MR) or mitral annular disjunction (MAD), limiting our understanding of alternative arrhythmic mechanisms in MVP. We sought to evaluate the association between interstitial fibrosis and AMVP, regardless of MAD and without severe MR, while also investigating the contribution of sex to this association.

Methods: We performed research-based contrast CMR in consecutive individuals with MVP between 2019 and 2022. Extracellular volume fraction (ECV%), a surrogate marker for interstitial fibrosis, was quantified using T1 mapping in the basal and mid-LV slices. Replacement fibrosis was assessed using late gadolinium enhancement (LGE). AMVP was defined as MVP with frequent premature ventricular contractions and/or non-sustained/sustained ventricular tachycardia (VT) or fibrillation (VF).

Results: We identified 65 MVP cases without severe MR (46% women, 34% no/trace, 44% mild, and 21% moderate MR) and with adequate ECV% measurement. Among these, 38% were classified as AMVP, including two cases of aborted VF arrest, both in premenopausal females. Global ECV% was significantly higher in AMVP versus non-AMVP (31%[27-33] vs 27%[23-30], p=0.002). In the AMVP group, higher segmental ECV% was not limited to the inferolateral/inferior walls, typically subject to myocardial traction by the prolapsing leaflets/MAD but was more diffuse and involved atypical segments such as the anterior/anterolateral walls (p<0.05). The association between AMVP and global ECV% was driven by female sex (32%[30-34] vs 27%[25-30], p=0.002 in females; 28%[23-32] vs 26%[23-30], p=0.41 in males). ECV% remained independently associated with an increased risk of arrhythmic events, including VT/VF (p<0.01), even after adjustment for cardiovascular risk factors, MAD, and LGE (p<0.01).

Conclusion: In MVP without significant MR, interstitial fibrosis by CMR is associated with an increased risk of arrhythmic events, suggesting a primary myopathic process. The selective association between interstitial fibrosis and AMVP in females may explain why severe arrhythmic complications are more prevalent among women.

间质纤维化与心律失常性二尖瓣脱垂:揭示性别差异。
背景:心律失常性二尖瓣脱垂(AMVP)是一种已知以女性为主的疾病,通过心脏磁共振(CMR)量化的间质纤维化已在这种疾病中得到证实。之前对 AMVP 间质纤维化的研究仅包括伴有明显二尖瓣反流(MR)或二尖瓣瓣环脱节(MAD)的病例,这限制了我们对 MVP 其他心律失常机制的了解。我们试图评估间质纤维化与AMVP之间的关系,无论MAD如何,也无论是否存在严重的MR,同时还研究了性别对这种关系的影响:我们在 2019 年至 2022 年期间对连续的 MVP 患者进行了基于研究的对比 CMR。细胞外体积分数(ECV%)是间质纤维化的替代标志物,我们使用 T1 映射对基底和左心室中段切片进行了量化。使用晚期钆增强(LGE)评估替代纤维化。AMVP定义为伴有频繁室性早搏和/或非持续性/持续性室速(VT)或室颤(VF)的MVP:我们发现了 65 例无严重 MR 的 MVP 病例(46% 为女性,34% 无 MR/微量 MR,44% 有轻度 MR,21% 有中度 MR),并进行了充分的 ECV% 测量。在这些病例中,38%被归类为AMVP,包括两例终止的室颤,均为绝经前女性。AMVP 与非 AMVP 相比,总体 ECV% 明显更高(31%[27-33] vs 27%[23-30],P=0.002)。在AMVP组中,较高的节段ECV%并不局限于下外侧/下壁,下外侧/下壁通常受到脱垂的小叶/MAD的心肌牵引,而是更加弥漫,并涉及非典型节段,如前壁/前外侧壁(P结论:在无明显 MR 的 MVP 患者中,CMR 显示的间质纤维化与心律失常事件的风险增加有关,表明这是一种原发性肌病过程。女性间质纤维化与 AMVP 之间的选择性关联可能解释了为什么严重的心律失常并发症在女性中更为普遍。
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来源期刊
CiteScore
10.90
自引率
12.50%
发文量
61
审稿时长
6-12 weeks
期刊介绍: Journal of Cardiovascular Magnetic Resonance (JCMR) publishes high-quality articles on all aspects of basic, translational and clinical research on the design, development, manufacture, and evaluation of cardiovascular magnetic resonance (CMR) methods applied to the cardiovascular system. Topical areas include, but are not limited to: New applications of magnetic resonance to improve the diagnostic strategies, risk stratification, characterization and management of diseases affecting the cardiovascular system. New methods to enhance or accelerate image acquisition and data analysis. Results of multicenter, or larger single-center studies that provide insight into the utility of CMR. Basic biological perceptions derived by CMR methods.
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