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You are here: Contents > 2013 > Volume 22 Number 5 September 2013 > MITRAL VALVE DISEASE > Is There an Alternative Explanation to Post-Myocardial Infarction Emergence of Mitral Regurgitation? A CMR-LGE Observational Study

Is There an Alternative Explanation to Post-Myocardial Infarction Emergence of Mitral Regurgitation? A CMR-LGE Observational Study

Hari Bogabathina, Mark Doyle, Ronald Williams, June Yamrozik, Diane Vido, Robert W. W. Biederman

Department of Cardiovascular Magnetic Resonance, Gerald McGinnis Cardiovascular Institute, Allegheny General Hospital, Pittsburgh, PA, USA

Background and aim of the study: Post-myocardial infarction (MI) mitral regurgitation (MR) is thought to be due to a passive, rather than active, remodelling of the mitral valve apparatus and its relationship with other cardiac structures that contribute to MR. Standard contrast-enhanced magnetic resonance (CMR) late gadolinium enhancement (LGE) may be sensitive to non-myocardial pathology involving the mitral valve leaflets. It was hypothesized that the presence of mitral valve enhancement (MVE) on LGE imaging in post-MI patients would be associated with an increased incidence of MR.

Methods: The presence or absence of MVE was noted in patients presenting for CMR with MI and non-MI indications requiring LGE. A chi-square analysis was performed for non-contiguous variables; SPSS (Chicago) software was utilized for the statistical analysis.

Results: Eighty-seven patients (54 males, 33 females) underwent LGE-CMR studies utilizing a 1.5 T GE scanner with MultiHance gadolinium contrast administration. LGE+

(present) was noted in 68 patients, and LGE- (absent) in 19 patients. Post-MI patterns of LGE+ were noted in 51 patients and LGE- in 36 patients; MVE+ was noted in 39 patients and MVE- in 48; and MR+ was present in 67 patients and absent (MR-) in 20 patients. MVE was observed chiefly in post-MI patients (33/51; 65%) and infrequently in non-post-MI patients (6/36; 17%; χ2 = 17.8, p <0.001, power = 0.995). Further, MR was present more frequently in patients with MVE (36/39; 92%) compared to patients without MVE (31/48; 65%; χ2 = 7.8, p = 0.005, power = 0.814).

Conclusion: MVE is present in a large number of post-MI patients but rarely in non-post-MI patients. Post-MI patients with, rather than without, MVE are far more likely to have MR. These observations suggest a specific but as-yet unknown reactive process that may contribute to mitral leaflet remodelling in post-MI patients, potentially contributing to an increased incidence of MR in post-MI patients.

The Journal of Heart Valve Disease 2013;22:669-674


Is There an Alternative Explanation to Post-Myocardial Infarction Emergence of Mitral Regurgitation? A CMR-LGE Observational Study

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