Myocardial Fibrosis Relates to Abnormal Myocardial Mechanics in Patients With Mitral Valve Prolapse

Nagata, Yasufumi; Bertrand, P.; Dal‐Bianco, Jacob P.; Melnitchouk, Serguei; Baliyan, Vinit; Holmvang, Fred; Norris, Russell A.; Guerrero, J. Luis; Borger, Michael A.; Moore, Reece; Hua, Lanqi; Sultana, Razia; Yum, Brian; Neilan, Tomas G.; Picard, Michael H.; Kim, Jiwon; Francesca, Delling N.; Weinsaft, Jonathan W.; Hung, Judy; Levine, Robert A.

doi:10.1016/s0735-1097(20)32174-4

Cited by 8 publications

(11 citation statements)

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“…In future, interactions of valves with annular and ventricular structures provide opportunities to study the intersection of biomechanics and molecular changes through understanding how flattening the mitral annular saddle can augment leaflet stresses and worsen mitral valve prolapse 25 ; how prolapse-induced forces can generate localized, proarrhythmic ventricular fibrosis 26 ; and how local and global remodeling of the ischemic or myopathic ventricle can trigger intrinsic valve changes.…”

Section: Gaps In Knowledge: Mitral Valve Diseasementioning

confidence: 99%

Challenges and Opportunities in Valvular Heart Disease: From Molecular Mechanisms to the Community

Aikawa,

Blaser,

Singh

et al. 2024

ATVB

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Section: Gaps In Knowledge: Mitral Valve Diseasementioning

confidence: 99%

Challenges and Opportunities in Valvular Heart Disease: From Molecular Mechanisms to the Community

Aikawa,

Blaser,

Singh

et al. 2024

ATVB

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“…Diffuse interstitial fibrosis has been associated with ventricular arrhythmia in MVP patients and may be related to volume overload secondary to MR ( 22 ). On the other hand, localized fibrosis in myocardium adjacent to the PMs has been associated with ventricular arrhythmias and SCD in the absence of diffuse ventricular fibrosis ( 7 , 9 , 12 ). This supports the concept of mechanical stress from prolapsing valve structures causing localized fibrosis and subsequent arrhythmia substrate.…”

Section: Myocardial Fibrosis In Mvp and Fibrosis-related Remodelingmentioning

confidence: 99%

“…The excessive mobility of the prolapsing leaflets along with increased systolic annular expansion is paralleled by superior papillary muscle (PM) displacement and a systolic curling motion of the inferobasal left ventricle (LV) wall (4)(5)(6). The structural link to the valve and potentially increased mechanical stress have previously been suggested as a possible mechanism for myocyte hypertrophy and fibrosis in these areas (7)(8)(9)(10). According to this hypothetic mechanism, biomechanical stress might play a central role in the pathophysiology of the subvalvular and surrounding ventricular structural changes, i.e., replacement fibrosis, that occur secondary to MVP (11).…”

Section: Introductionmentioning

confidence: 99%

“…According to this hypothetic mechanism, biomechanical stress might play a central role in the pathophysiology of the subvalvular and surrounding ventricular structural changes, i.e., replacement fibrosis, that occur secondary to MVP ( 11 ). Such fibrosis is clinically relevant because of a demonstrated association with ventricular arrhythmias and sudden cardiac death (SCD) ( 7 , 9 , 12 ). Cardiovascular imaging is the clinical noninvasive method used to detect myocardial fibrosis ( 13 ), while histological assessment is the validation standard for its detection and quantification ( 14 , 15 ).…”

Section: Introductionmentioning

confidence: 99%

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Histopathological insights into mitral valve prolapse-induced fibrosis

Dieterlen

Klaeske²,

Spampinato³

et al. 2023

Front. Cardiovasc. Med.

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Mitral valve prolapse (MVP) is a cardiac valve disease that not only affects the mitral valve (MV), provoking mitral regurgitation, but also leads to maladaptive structural changes in the heart. Such structural changes include the formation of left ventricular (LV) regionalized fibrosis, especially affecting the papillary muscles and inferobasal LV wall. The occurrence of regional fibrosis in MVP patients is hypothesized to be a consequence of increased mechanical stress on the papillary muscles and surrounding myocardium during systole and altered mitral annular motion. These mechanisms appear to induce fibrosis in valve-linked regions, independent of volume-overload remodeling effects of mitral regurgitation. In clinical practice, quantification of myocardial fibrosis is performed with cardiovascular magnetic resonance (CMR) imaging, even though CMR has sensitivity limitations in detecting myocardial fibrosis, especially in detecting interstitial fibrosis. Regional LV fibrosis is clinically relevant because even in the absence of mitral regurgitation, it has been associated with ventricular arrhythmias and sudden cardiac death in MVP patients. Myocardial fibrosis may also be associated with LV dysfunction following MV surgery. The current article provides an overview of current histopathological studies investigating LV fibrosis and remodeling in MVP patients. In addition, we elucidate the ability of histopathological studies to quantify fibrotic remodeling in MVP and gain deeper understanding of the pathophysiological processes. Furthermore, molecular changes such as alterations in collagen expression in MVP patients are reviewed.

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“…In this issue of Circulation: Cardiovascular Imaging , Nagata and Bertrand et al 5 reported a novel double-peak pattern (DPP) on speckle-tracking echocardiography–derived longitudinal strain curves in patients with MVP. As the name implies, DPP is characterized by 2 distinct peaks.…”

mentioning

confidence: 99%

New Kid on the Block: Double-Peak Strain Pattern in Arrhythmic Mitral Valve Prolapse

Lancellotti

2023

Circ: Cardiovascular Imaging

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Myocardial Fibrosis Relates to Abnormal Myocardial Mechanics in Patients With Mitral Valve Prolapse

Cited by 8 publications

References 0 publications

Challenges and Opportunities in Valvular Heart Disease: From Molecular Mechanisms to the Community

Challenges and Opportunities in Valvular Heart Disease: From Molecular Mechanisms to the Community

Histopathological insights into mitral valve prolapse-induced fibrosis

New Kid on the Block: Double-Peak Strain Pattern in Arrhythmic Mitral Valve Prolapse

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