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Myocardial extracellular volume by T1 mapping: a new marker of arrhythmia in mitral valve prolapse
Journal of Cardiovascular Magnetic Resonance ( IF 6.4 ) Pub Date : 2021-09-13 , DOI: 10.1186/s12968-021-00797-2 Anna Giulia Pavon 1, 2, 3 , Dimitri Arangalage 1 , Patrizio Pascale 1, 4 , Sarah Hugelshofer 1, 2 , Tobias Rutz 1, 2, 4 , Alessandra Pia Porretta 1 , Mathieu Le Bloa 1 , Olivier Muller 1, 4 , Etienne Pruvot 1, 4 , Juerg Schwitter 1, 2, 4 , Pierre Monney 1, 2, 4
Journal of Cardiovascular Magnetic Resonance ( IF 6.4 ) Pub Date : 2021-09-13 , DOI: 10.1186/s12968-021-00797-2 Anna Giulia Pavon 1, 2, 3 , Dimitri Arangalage 1 , Patrizio Pascale 1, 4 , Sarah Hugelshofer 1, 2 , Tobias Rutz 1, 2, 4 , Alessandra Pia Porretta 1 , Mathieu Le Bloa 1 , Olivier Muller 1, 4 , Etienne Pruvot 1, 4 , Juerg Schwitter 1, 2, 4 , Pierre Monney 1, 2, 4
Affiliation
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. In MVP, MAD has been associated with myocardial replacement fibrosis and arrhythmia, but the importance of interstitial fibrosis remains unknown. 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. 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. 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.
中文翻译:
T1 测绘的心肌细胞外体积:二尖瓣脱垂心律失常的新标志物
我们旨在评估二尖瓣脱垂 (MVP) 患者二尖瓣环分离 (MAD) 严重程度与左心室 (LV) 基底部心肌间质纤维化之间的关系,并评估间质纤维化严重程度与发生室性心律失常事件。在 MVP 中,MAD 与心肌替代纤维化和心律失常有关,但间质纤维化的重要性仍然未知。在这项回顾性研究中,30 名 MVP 和 MAD (MVP-MAD) 患者接受了心血管磁共振 (CMR),评估 MAD 长度、钆延迟增强 (LGE) 和基底节段心肌细胞外体积 (ECVsyn)。对照组包括14例二尖瓣关闭不全(MR)但无MAD(MR-NoMAD)患者和10例CMR正常(NoMR-NoMAD)患者。15 名 MVP-MAD 患者接受了 24 小时动态心电图监测。在 47% 的 MVP-MAD 患者中观察到 LGE,而在所有对照中均不存在。ECVsyn 在 MVP-MAD 中更高(30 ± 3% vs 24 ± 3% MR-NoMAD,p < 0.001 和 vs 24 ± 2% NoMR-NoMAD,p < 0.001),即使在没有 LGE 的 MVP-MAD 患者中也是如此(29 ± 3% vs 24 ± 3%, p < 0.001 和 vs 24 ± 2%, p < 0.001)。MAD 长度与 ECVsyn 相关(rho = 0.61,p < 0.001),但与 LGE 范围无关。4 名患者有院外心脏骤停病史;LGE 和 ECVsyn 在识别那些高风险患者方面的性能相同,受试者操作特征 (ROC) 曲线下面积为 0.81 对 0.83,p = 0.84)。在 Holter 患者中,87% 有复杂的室性心律失常。ECVsyn 总体上高于临界值,而只有 53% 有 LGE。ECVsyn 增加,间质纤维化的标志物,即使在没有 LGE 的情况下也会发生在 MVP-MAD 中,并且与 MAD 长度和院外心脏骤停风险增加相关。ECV 应包括在 MVP 患者的 CMR 检查中,以更好地评估纤维重构,因为它可能在心律失常风险分层中提供超出 LGE 评估的额外价值。
更新日期:2021-09-14
中文翻译:
T1 测绘的心肌细胞外体积:二尖瓣脱垂心律失常的新标志物
我们旨在评估二尖瓣脱垂 (MVP) 患者二尖瓣环分离 (MAD) 严重程度与左心室 (LV) 基底部心肌间质纤维化之间的关系,并评估间质纤维化严重程度与发生室性心律失常事件。在 MVP 中,MAD 与心肌替代纤维化和心律失常有关,但间质纤维化的重要性仍然未知。在这项回顾性研究中,30 名 MVP 和 MAD (MVP-MAD) 患者接受了心血管磁共振 (CMR),评估 MAD 长度、钆延迟增强 (LGE) 和基底节段心肌细胞外体积 (ECVsyn)。对照组包括14例二尖瓣关闭不全(MR)但无MAD(MR-NoMAD)患者和10例CMR正常(NoMR-NoMAD)患者。15 名 MVP-MAD 患者接受了 24 小时动态心电图监测。在 47% 的 MVP-MAD 患者中观察到 LGE,而在所有对照中均不存在。ECVsyn 在 MVP-MAD 中更高(30 ± 3% vs 24 ± 3% MR-NoMAD,p < 0.001 和 vs 24 ± 2% NoMR-NoMAD,p < 0.001),即使在没有 LGE 的 MVP-MAD 患者中也是如此(29 ± 3% vs 24 ± 3%, p < 0.001 和 vs 24 ± 2%, p < 0.001)。MAD 长度与 ECVsyn 相关(rho = 0.61,p < 0.001),但与 LGE 范围无关。4 名患者有院外心脏骤停病史;LGE 和 ECVsyn 在识别那些高风险患者方面的性能相同,受试者操作特征 (ROC) 曲线下面积为 0.81 对 0.83,p = 0.84)。在 Holter 患者中,87% 有复杂的室性心律失常。ECVsyn 总体上高于临界值,而只有 53% 有 LGE。ECVsyn 增加,间质纤维化的标志物,即使在没有 LGE 的情况下也会发生在 MVP-MAD 中,并且与 MAD 长度和院外心脏骤停风险增加相关。ECV 应包括在 MVP 患者的 CMR 检查中,以更好地评估纤维重构,因为它可能在心律失常风险分层中提供超出 LGE 评估的额外价值。