Myocardial fibrosis in asymptomatic and symptomatic chronic severe primary mitral regurgitation and relationship to tissue characterisation and left ventricular function on cardiovascular magnetic resonance

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Myocardial fibrosis in asymptomatic and symptomatic chronic severe primary mitral regurgitation and relationship to tissue characterisation and left ventricular function on cardiovascular magnetic resonance. / Liu, Boyang; Neil, Desley A H; Premchand, Monisha; Bhabra, Moninder; Patel, Ramesh; Barker, Thomas; Nikolaidis, Nicolas; Billing, J Stephen; Treibel, Thomas A; Moon, James C; González, Arantxa; Hodson, James; Edwards, Nicola C; Steeds, Richard P.

In: Journal of Cardiovascular Magnetic Resonance, Vol. 22, No. 1, 86, 14.12.2020.

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Liu, Boyang ; Neil, Desley A H ; Premchand, Monisha ; Bhabra, Moninder ; Patel, Ramesh ; Barker, Thomas ; Nikolaidis, Nicolas ; Billing, J Stephen ; Treibel, Thomas A ; Moon, James C ; González, Arantxa ; Hodson, James ; Edwards, Nicola C ; Steeds, Richard P. / Myocardial fibrosis in asymptomatic and symptomatic chronic severe primary mitral regurgitation and relationship to tissue characterisation and left ventricular function on cardiovascular magnetic resonance. In: Journal of Cardiovascular Magnetic Resonance. 2020 ; Vol. 22, No. 1.

Bibtex

@article{f1c11bc06c134189abe29ef53295fe5d,
title = "Myocardial fibrosis in asymptomatic and symptomatic chronic severe primary mitral regurgitation and relationship to tissue characterisation and left ventricular function on cardiovascular magnetic resonance",
abstract = "BACKGROUND: Myocardial fibrosis occurs in end-stage heart failure secondary to mitral regurgitation (MR), but it is not known whether this is present before onset of symptoms or myocardial dysfunction. This study aimed to characterise myocardial fibrosis in chronic severe primary MR on histology, compare this to tissue characterisation on cardiovascular magnetic resonance (CMR) imaging, and investigate associations with symptoms, left ventricular (LV) function, and exercise capacity.METHODS: Patients with class I or IIa indications for surgery underwent CMR and cardiopulmonary exercise testing. LV biopsies were taken at surgery and the extent of fibrosis was quantified on histology using collagen volume fraction (CVFmean) compared to autopsy controls without cardiac pathology.RESULTS: 120 consecutive patients (64 ± 13 years; 71% male) were recruited; 105 patients underwent MV repair while 15 chose conservative management. LV biopsies were obtained in 86 patients (234 biopsy samples in total). MR patients had more fibrosis compared to 8 autopsy controls (median: 14.6% [interquartile range 7.4-20.3] vs. 3.3% [2.6-6.1], P < 0.001); this difference persisted in the asymptomatic patients (CVFmean 13.6% [6.3-18.8], P < 0.001), but severity of fibrosis was not significantly higher in NYHA II-III symptomatic MR (CVFmean 15.7% [9.9-23.1] (P = 0.083). Fibrosis was patchy across biopsy sites (intraclass correlation 0.23, 95% CI 0.08-0.39, P = 0.001). No significant relationships were identified between CVFmean and CMR tissue characterisation [native T1, extracellular volume (ECV) or late gadolinium enhancement] or measures of LV function [LV ejection fraction (LVEF), global longitudinal strain (GLS)]. Although the range of ECV was small (27.3 ± 3.2%), ECV correlated with multiple measures of LV function (LVEF: Rho = - 0.22, P = 0.029, GLS: Rho = 0.29, P = 0.003), as well as NTproBNP (Rho = 0.54, P < 0.001) and exercise capacity (%PredVO2max: R = - 0.22, P = 0.030).CONCLUSIONS: Patients with chronic primary MR have increased fibrosis before the onset of symptoms. Due to the patchy nature of fibrosis, CMR derived ECV may be a better marker of global myocardial status. Clinical trial registration Mitral FINDER study; Clinical Trials NCT02355418, Registered 4 February 2015, https://clinicaltrials.gov/ct2/show/NCT02355418.",
keywords = "Aged, Asymptomatic Diseases, Biopsy, Case-Control Studies, Chronic Disease, Disease Progression, England, Exercise Test, Exercise Tolerance, Female, Fibrosis, Humans, Magnetic Resonance Imaging, Cine, Male, Middle Aged, Mitral Valve Insufficiency/diagnostic imaging, Myocardium/pathology, Predictive Value of Tests, Prospective Studies, Severity of Illness Index, Ventricular Function, Left, Ventricular Remodeling",
author = "Boyang Liu and Neil, {Desley A H} and Monisha Premchand and Moninder Bhabra and Ramesh Patel and Thomas Barker and Nicolas Nikolaidis and Billing, {J Stephen} and Treibel, {Thomas A} and Moon, {James C} and Arantxa Gonz{\'a}lez and James Hodson and Edwards, {Nicola C} and Steeds, {Richard P}",
year = "2020",
month = dec,
day = "14",
doi = "10.1186/s12968-020-00674-4",
language = "English",
volume = "22",
journal = "Journal of Cardiovascular Magnetic Resonance",
issn = "1097-6647",
publisher = "Springer",
number = "1",

}

RIS

TY - JOUR

T1 - Myocardial fibrosis in asymptomatic and symptomatic chronic severe primary mitral regurgitation and relationship to tissue characterisation and left ventricular function on cardiovascular magnetic resonance

AU - Liu, Boyang

AU - Neil, Desley A H

AU - Premchand, Monisha

AU - Bhabra, Moninder

AU - Patel, Ramesh

AU - Barker, Thomas

AU - Nikolaidis, Nicolas

AU - Billing, J Stephen

AU - Treibel, Thomas A

AU - Moon, James C

AU - González, Arantxa

AU - Hodson, James

AU - Edwards, Nicola C

AU - Steeds, Richard P

PY - 2020/12/14

Y1 - 2020/12/14

N2 - BACKGROUND: Myocardial fibrosis occurs in end-stage heart failure secondary to mitral regurgitation (MR), but it is not known whether this is present before onset of symptoms or myocardial dysfunction. This study aimed to characterise myocardial fibrosis in chronic severe primary MR on histology, compare this to tissue characterisation on cardiovascular magnetic resonance (CMR) imaging, and investigate associations with symptoms, left ventricular (LV) function, and exercise capacity.METHODS: Patients with class I or IIa indications for surgery underwent CMR and cardiopulmonary exercise testing. LV biopsies were taken at surgery and the extent of fibrosis was quantified on histology using collagen volume fraction (CVFmean) compared to autopsy controls without cardiac pathology.RESULTS: 120 consecutive patients (64 ± 13 years; 71% male) were recruited; 105 patients underwent MV repair while 15 chose conservative management. LV biopsies were obtained in 86 patients (234 biopsy samples in total). MR patients had more fibrosis compared to 8 autopsy controls (median: 14.6% [interquartile range 7.4-20.3] vs. 3.3% [2.6-6.1], P < 0.001); this difference persisted in the asymptomatic patients (CVFmean 13.6% [6.3-18.8], P < 0.001), but severity of fibrosis was not significantly higher in NYHA II-III symptomatic MR (CVFmean 15.7% [9.9-23.1] (P = 0.083). Fibrosis was patchy across biopsy sites (intraclass correlation 0.23, 95% CI 0.08-0.39, P = 0.001). No significant relationships were identified between CVFmean and CMR tissue characterisation [native T1, extracellular volume (ECV) or late gadolinium enhancement] or measures of LV function [LV ejection fraction (LVEF), global longitudinal strain (GLS)]. Although the range of ECV was small (27.3 ± 3.2%), ECV correlated with multiple measures of LV function (LVEF: Rho = - 0.22, P = 0.029, GLS: Rho = 0.29, P = 0.003), as well as NTproBNP (Rho = 0.54, P < 0.001) and exercise capacity (%PredVO2max: R = - 0.22, P = 0.030).CONCLUSIONS: Patients with chronic primary MR have increased fibrosis before the onset of symptoms. Due to the patchy nature of fibrosis, CMR derived ECV may be a better marker of global myocardial status. Clinical trial registration Mitral FINDER study; Clinical Trials NCT02355418, Registered 4 February 2015, https://clinicaltrials.gov/ct2/show/NCT02355418.

AB - BACKGROUND: Myocardial fibrosis occurs in end-stage heart failure secondary to mitral regurgitation (MR), but it is not known whether this is present before onset of symptoms or myocardial dysfunction. This study aimed to characterise myocardial fibrosis in chronic severe primary MR on histology, compare this to tissue characterisation on cardiovascular magnetic resonance (CMR) imaging, and investigate associations with symptoms, left ventricular (LV) function, and exercise capacity.METHODS: Patients with class I or IIa indications for surgery underwent CMR and cardiopulmonary exercise testing. LV biopsies were taken at surgery and the extent of fibrosis was quantified on histology using collagen volume fraction (CVFmean) compared to autopsy controls without cardiac pathology.RESULTS: 120 consecutive patients (64 ± 13 years; 71% male) were recruited; 105 patients underwent MV repair while 15 chose conservative management. LV biopsies were obtained in 86 patients (234 biopsy samples in total). MR patients had more fibrosis compared to 8 autopsy controls (median: 14.6% [interquartile range 7.4-20.3] vs. 3.3% [2.6-6.1], P < 0.001); this difference persisted in the asymptomatic patients (CVFmean 13.6% [6.3-18.8], P < 0.001), but severity of fibrosis was not significantly higher in NYHA II-III symptomatic MR (CVFmean 15.7% [9.9-23.1] (P = 0.083). Fibrosis was patchy across biopsy sites (intraclass correlation 0.23, 95% CI 0.08-0.39, P = 0.001). No significant relationships were identified between CVFmean and CMR tissue characterisation [native T1, extracellular volume (ECV) or late gadolinium enhancement] or measures of LV function [LV ejection fraction (LVEF), global longitudinal strain (GLS)]. Although the range of ECV was small (27.3 ± 3.2%), ECV correlated with multiple measures of LV function (LVEF: Rho = - 0.22, P = 0.029, GLS: Rho = 0.29, P = 0.003), as well as NTproBNP (Rho = 0.54, P < 0.001) and exercise capacity (%PredVO2max: R = - 0.22, P = 0.030).CONCLUSIONS: Patients with chronic primary MR have increased fibrosis before the onset of symptoms. Due to the patchy nature of fibrosis, CMR derived ECV may be a better marker of global myocardial status. Clinical trial registration Mitral FINDER study; Clinical Trials NCT02355418, Registered 4 February 2015, https://clinicaltrials.gov/ct2/show/NCT02355418.

KW - Aged

KW - Asymptomatic Diseases

KW - Biopsy

KW - Case-Control Studies

KW - Chronic Disease

KW - Disease Progression

KW - England

KW - Exercise Test

KW - Exercise Tolerance

KW - Female

KW - Fibrosis

KW - Humans

KW - Magnetic Resonance Imaging, Cine

KW - Male

KW - Middle Aged

KW - Mitral Valve Insufficiency/diagnostic imaging

KW - Myocardium/pathology

KW - Predictive Value of Tests

KW - Prospective Studies

KW - Severity of Illness Index

KW - Ventricular Function, Left

KW - Ventricular Remodeling

U2 - 10.1186/s12968-020-00674-4

DO - 10.1186/s12968-020-00674-4

M3 - Article

C2 - 33308240

VL - 22

JO - Journal of Cardiovascular Magnetic Resonance

JF - Journal of Cardiovascular Magnetic Resonance

SN - 1097-6647

IS - 1

M1 - 86

ER -