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Cardiovascular Magnetic Resonance Characterization of Mitral Valve Prolapse

Yuchi Han, MD^_*,_*, Dana C. Peters, PhD^_*, Carol J. Salton, BA^_*, Dorota Bzymek, RDCS^_*, Reza Nezafat, PhD^_*, Beth Goddu, RT(R)(MR)^_*, Kraig V. Kissinger, RT(R)(MR)^_*, Peter J. Zimetbaum, MD^_*, Warren J. Manning, MD^_*,, Susan B. Yeon, MD, JD^_*

^_* Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.

^_* Reprint requests and correspondence: Dr. Yuchi Han, Cardiovascular Division, E/SH-457, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, Massachusetts 02215. (Email: yhan{at}bidmc.harvard.edu).

Objectives: This study sought to develop cardiovascular magnetic resonance (CMR) diagnostic criteria for mitral valve prolapse (MVP) using echocardiography as the gold standard and to characterize MVP using cine CMR and late gadolinium enhancement (LGE)-CMR.

Background: Mitral valve prolapse is a common valvular heart disease with significant complications. Cardiovascular magnetic resonance is a valuable imaging tool for assessing ventricular function, quantifying regurgitant lesions, and identifying fibrosis, but its potential role in evaluating MVP has not been defined.

Methods: To develop CMR diagnostic criteria for MVP, characterize mitral valve morphology, we analyzed transthoracic echocardiography and cine CMR images from 25 MVP patients and 25 control subjects. Leaflet thickness, length, mitral annular diameters, and prolapsed distance were measured. Two- and three-dimensional LGE-CMR images were obtained in 16 MVP and 10 control patients to identify myocardial regions of fibrosis in MVP.

Results: We found that a 2-mm threshold for leaflet excursion into the left atrium in the left ventricular outflow tract long-axis view yielded 100% sensitivity and 100% specificity for CMR using transthoracic echocardiography as the clinical gold standard. Compared with control subjects, CMR identified MVP patients as having thicker (3.2 ± 0.1 mm vs. 2.3 ± 0.1 mm) and longer (10.5 ± 0.5 mm/m² vs. 7.1 ± 0.3 mm/m²) indexed posterior leaflets and larger indexed mitral annular diameters (27.8 ± 0.7 mm/m² vs. 21.5 ± 0.5 mm/m² for long axis and 22.9 ±0.7 mm/m² vs. 17.8 ± 0.6 mm/m² for short axis). In addition, we identified focal regions of LGE in the papillary muscles suggestive of fibrosis in 10 (63%) of 16 MVP patients and in 0 of 10 control subjects. Papillary muscle LGE was associated with the presence of complex ventricular arrhythmias in MVP patients.

Conclusions: Cardiovascular magnetic resonance image can identify MVP by the same echocardiographic criteria and can identify myocardial fibrosis involving the papillary muscle in MVP patients. Hyperenhancement of papillary muscles on LGE is often present in a subgroup of patients with complex ventricular arrhythmias.

Abbreviations and Acronyms   2C = two chambers   2D = two-dimensional   3D = three-dimensional   4C = four chambers   CMR = cardiovascular magnetic resonance   CVA = complex ventricular arrhythmia   ECG = electrocardiogram   EF = ejection fraction   LGE = late gadolinium enhancement   LV = left ventricular   LVOT = left ventricular outflow tract   MAD = mitral annular diameter   MR = mitral regurgitation   MVP = mitral valve prolapse   SSFP = steady state free processing   TTE = transthoracic echocardiography

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Mitral Valve Prolapse: A Deeper Look

Robert A. Levine and Ronen Durst
J. Am. Coll. Cardiol. Img. 2008 1: 304-306. [Full Text] [PDF]

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				R. A. Levine and R. Durst Mitral Valve Prolapse: A Deeper Look J. Am. Coll. Cardiol. Img., May 1, 2008; 1(3): 304 - 306. [Full Text] [PDF]