Advanced chronic rheumatic heart disease is associated with substantial myocardial and valvular fibrosis on cardiovascular magnetic resonance

Abstract

Rheumatic heart disease (RHD) is a major public health concern, particularly in low- and middle-income countries, with a reported 33.4 million cases globally and 319,400 annual deaths. Cardiovascular magnetic resonance (CMR) is a reliable non-invasive technique that detects fibrosis and inflammation in cardiovascular diseases. We assessed myocardial tissue characteristics in chronic RHD using multiparametric CMR. Forty-seven (47) patients with severe, advanced RHD booked for valve replacement surgery, diagnosed on echocardiography, and matched with thirty healthy controls, were scanned using a 3T Siemens Magnetom Skyra. Baseline demographic and clinical characteristics, CMR findings including late gadolinium enhancement (LGE), T1 mapping and ECV measurements were reported. Mean age of patients was 42 ± 12.8 years; 62% (39 ± 12.1 years) female. LGE CMR detected focal myocardial fibrosis in 100% of RHD patients vs. 7% of controls (p < 0.001). In all RHD patients, LGE involving all segments was observed. Patterns of LGE were linear (26%), patchy (36%) and diffuse (38%). We also report elevated mean native T1 (p < 0.004) and ECV (p < 0.001) in all RHD patients compared to controls, respectively. Myocardial fibrosis is abundant in patients with severe, chronic RHD. CMR can be utilised for non-invasive diagnosis of fibrosis and for tracking of disease progression.