ArticleJournal of cardiovascular magnetic resonance : official journal of the Society for Cardiovascular Magnetic Resonance2024
Interstitial fibrosis and arrhythmic mitral valve prolapse: Unraveling sex-based differences.
Article in Journal of cardiovascular magnetic resonance : official journal of the Society for Cardiovascular Magnetic Resonance, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers.
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Who cites it
11 citing papers in PubMed.
- Arrhythmic Mitral Valve Prolapse as a Regional Stretch-Induced Cardiomyopathy with Fibro-Inflammatory Signature: A Conceptual Review.Journal of cardiovascular development and disease · 2026Review
- Evaluation of mitral valve parameters with gender and age in the Pakistani population: A 2-dimensional echocardiographic study.Pakistan journal of medical sciences · 2026Article
- Utility of genetic screening for the prediction of severe arrhythmic outcomes in mitral valve prolapse.medRxiv : the preprint server for health sciences · 2026Article
- Leveraging Self-Reporting in an Existing e-Cohort to Identify Clinically Relevant Mitral Valve Prolapse: Pilot Questionnaire Study.JMIR formative research · 2026Article
- Prevalence, Genetics, and Imaging Characteristics of Patients with Mitral Valve Prolapse and Arrhythmogenic Right Ventricular Cardiomyopathy.medRxiv : the preprint server for health sciences · 2026Article
- The Arrhythmogenic Spectrum of Mitral Valve Disease: Pathophysiology, Risk Stratification, and Surgical Management.Journal of clinical medicine · 2026Review
- Sex-Based Differences in Mitral Annular Disjunction Severity and Arrhythmic Risk in Mitral Valve Prolapse.Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography · 2026Article
- Multimodality cardiovascular imaging in arrhythmic mitral valve prolapse: a state-of-the-art review from structural assessment to myocardial tissue characterization.Frontiers in cardiovascular medicine · 2026Review
- Phenotyping of Mitral Valve Prolapse Without Severe Mitral Regurgitation Using Electrocardiographic and Echocardiographic Data.JACC. Clinical electrophysiology · 2025Article
- Mitral Annular Disjunction: Epidemiology, Diagnostic Methods, Prognosis, and Novel Implications.Journal of cardiovascular development and disease · 2025Review
- Multimodality Imaging of Arrhythmic Risk in Mitral Valve Prolapse.Circulation. Cardiovascular imaging · 2025Review
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Authors and funding
13 authors.
Funding
Abstract
backgroundInterstitial fibrosis as quantified by cardiovascular magnetic resonance (CMR) has been demonstrated in arrhythmic mitral valve prolapse (AMVP), a condition with known female predominance. Prior studies of interstitial fibrosis in AMVP have only included cases with significant mitral regurgitation (MR) or mitral annular disjunction (MAD), limiting our understanding of alternative arrhythmic mechanisms in mitral valve prolapse (MVP). We sought to evaluate the association between interstitial fibrosis and AMVP, regardless of MAD and without severe MR, while also investigating the contribution of sex to this association.
methodsWe performed research-based contrast CMR in consecutive individuals with MVP between 2019 and 2022. Extracellular volume fraction (ECV%), a surrogate marker for interstitial fibrosis, was quantified using T
resultsWe identified 65 MVP cases without severe MR (30 [46%] women, 22 [34%] no/trace, 30 [44%] mild, and 13 [21%] moderate MR) and with adequate ECV% measurement. Among these, 38% were classified as AMVP, including two cases of aborted VF arrest, both in premenopausal females. Global ECV% was significantly higher in AMVP vs non-AMVP (31% [27-33] vs 27% [23-30], p = 0.002). In the AMVP group, higher segmental ECV% was not limited to the inferolateral/inferior walls, typically subject to myocardial traction by the prolapsing leaflets/MAD but was more diffuse and involved atypical segments such as the anterior/anterolateral walls (p < 0.05). The association between AMVP and global ECV% was driven by female sex (32% [30-34] vs 27% [25-30], p = 0.002 in females; 28% [23-32] vs 26% [23-30], p = 0.41 in males). ECV% remained independently associated with an increased risk of arrhythmic events, including VT/VF (p < 0.01), even after adjustment for cardiovascular risk factors, MAD, and LGE (p < 0.01).
conclusionIn MVP without significant MR, interstitial fibrosis by CMR is associated with an increased risk of arrhythmic events, suggesting a primary myopathic process. The selective association between interstitial fibrosis and AMVP in females may explain why severe arrhythmic complications are more prevalent among women.
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