REVIEW
Cardiac magnetic resonance imaging in the evaluation and management of mitral valve prolapse – a comprehensive review
Francesco Mangini MD,
Maria Scarcia MD,
Robert W. W. Biederman MD,
Roberto Calbi MD,
Francesco Spinelli MD,
Grazia Casavecchia PhD,
Natale Daniele Brunetti PhD,
Matteo Gravina MD,
Corrado Fiore MD,
Sergio Suma MD,
Maria Milo MD,
Cristiano Turchetti MD,
Ernesto Pesce,
Remo Caramia MD,
Francesca Lombardi MD,
Massimo Grimaldi PhD,
Corresponding Author
Francesco Mangini MD
Department of Cardiology, Ospedale Regionale “Miulli”, Acquaviva delle Fonti, BA, Italy
Correspondence
Francesco Mangini, Department of Cardiology, Ospedale Regionale “Miulli”, Acquaviva delle Fonti, BA, Italy.
Email: [email protected]
Search for more papers by this authorMaria Scarcia MD
Department of Cardiology, Ospedale Regionale “Miulli”, Acquaviva delle Fonti, BA, Italy
Search for more papers by this authorRobert W. W. Biederman MD
Cardiology Department, Roper St Francis Healthcare, Charleston, South Carolina, USA
Search for more papers by this authorRoberto Calbi MD
Department of Cardiology, Ospedale Regionale “Miulli”, Acquaviva delle Fonti, BA, Italy
Search for more papers by this authorFrancesco Spinelli MD
Department of Cardiology, Ospedale Regionale “Miulli”, Acquaviva delle Fonti, BA, Italy
Search for more papers by this authorGrazia Casavecchia PhD
Cardiology Department, University of Foggia, Foggia, Italy
Search for more papers by this authorNatale Daniele Brunetti PhD
Cardiology Department, University of Foggia, Foggia, Italy
Search for more papers by this authorMatteo Gravina MD
Radiology Department, University of Foggia, Foggia, Italy
Search for more papers by this authorCorrado Fiore MD
Department of Cardiology, Citta di Lecce Hospital, Novoli (Lecce), Puglia, Italy
Search for more papers by this authorSergio Suma MD
Department of Cardiology, Azienda Ospedaliero Universitaria di Parma, Parma, Italy
Search for more papers by this authorMaria Milo MD
Department of Cardiology, Ospedale “Di Summa – Perrino,” ASL Br, Brindisi, Italy
Search for more papers by this authorCristiano Turchetti MD
Madonna della Bruna Outpatients Clinic, Matera, Italy
Search for more papers by this authorErnesto Pesce
Madonna della Bruna Outpatients Clinic, Matera, Italy
Search for more papers by this authorRemo Caramia MD
Department of Anesthesiology, Ospedale “Camberlingo,” ASL Br, Francavilla Fontana, Italy
Search for more papers by this authorFrancesca Lombardi MD
Department of Cardiovascular Sciences, Università Cattolica del Sacro Cuore, Milano, Lombardia, Italy
Search for more papers by this authorMassimo Grimaldi PhD
Department of Cardiology, Ospedale Regionale “Miulli”, Acquaviva delle Fonti, BA, Italy
Search for more papers by this authorFrancesco Mangini MD,
Maria Scarcia MD,
Robert W. W. Biederman MD,
Roberto Calbi MD,
Francesco Spinelli MD,
Grazia Casavecchia PhD,
Natale Daniele Brunetti PhD,
Matteo Gravina MD,
Corrado Fiore MD,
Sergio Suma MD,
Maria Milo MD,
Cristiano Turchetti MD,
Ernesto Pesce,
Remo Caramia MD,
Francesca Lombardi MD,
Massimo Grimaldi PhD,
Corresponding Author
Francesco Mangini MD
Department of Cardiology, Ospedale Regionale “Miulli”, Acquaviva delle Fonti, BA, Italy
Correspondence
Francesco Mangini, Department of Cardiology, Ospedale Regionale “Miulli”, Acquaviva delle Fonti, BA, Italy.
Email: [email protected]
Search for more papers by this authorMaria Scarcia MD
Department of Cardiology, Ospedale Regionale “Miulli”, Acquaviva delle Fonti, BA, Italy
Search for more papers by this authorRobert W. W. Biederman MD
Cardiology Department, Roper St Francis Healthcare, Charleston, South Carolina, USA
Search for more papers by this authorRoberto Calbi MD
Department of Cardiology, Ospedale Regionale “Miulli”, Acquaviva delle Fonti, BA, Italy
Search for more papers by this authorFrancesco Spinelli MD
Department of Cardiology, Ospedale Regionale “Miulli”, Acquaviva delle Fonti, BA, Italy
Search for more papers by this authorGrazia Casavecchia PhD
Cardiology Department, University of Foggia, Foggia, Italy
Search for more papers by this authorNatale Daniele Brunetti PhD
Cardiology Department, University of Foggia, Foggia, Italy
Search for more papers by this authorMatteo Gravina MD
Radiology Department, University of Foggia, Foggia, Italy
Search for more papers by this authorCorrado Fiore MD
Department of Cardiology, Citta di Lecce Hospital, Novoli (Lecce), Puglia, Italy
Search for more papers by this authorSergio Suma MD
Department of Cardiology, Azienda Ospedaliero Universitaria di Parma, Parma, Italy
Search for more papers by this authorMaria Milo MD
Department of Cardiology, Ospedale “Di Summa – Perrino,” ASL Br, Brindisi, Italy
Search for more papers by this authorCristiano Turchetti MD
Madonna della Bruna Outpatients Clinic, Matera, Italy
Search for more papers by this authorErnesto Pesce
Madonna della Bruna Outpatients Clinic, Matera, Italy
Search for more papers by this authorRemo Caramia MD
Department of Anesthesiology, Ospedale “Camberlingo,” ASL Br, Francavilla Fontana, Italy
Search for more papers by this authorFrancesca Lombardi MD
Department of Cardiovascular Sciences, Università Cattolica del Sacro Cuore, Milano, Lombardia, Italy
Search for more papers by this authorMassimo Grimaldi PhD
Department of Cardiology, Ospedale Regionale “Miulli”, Acquaviva delle Fonti, BA, Italy
Search for more papers by this authorFirst published: 30 July 2024
Abstract
Mitral valve prolapse is a common valve disorder that usually has a benign prognosis unless there is significant regurgitation or LV impairment. However, a subset of patients are at an increased risk of ventricular arrhythmias and sudden cardiac death, which has led to the recognition of “arrhythmic mitral valve prolapse” as a clinical entity. Emerging risk factors include mitral annular disjunction and myocardial fibrosis. While echocardiography remains the primary method of evaluation, cardiac magnetic resonance has become crucial in managing this condition. Cine magnetic resonance sequences provide accurate characterization of prolapse and annular disjunction, assessment of ventricular volumes and function, identification of early dysfunction and remodeling, and quantitative assessment of mitral regurgitation when integrated with flow imaging. However, the unique strength of magnetic resonance lies in its ability to identify tissue changes. T1 mapping sequences identify diffuse fibrosis, in turn related to early ventricular dysfunction and remodeling. Late gadolinium enhancement sequences detect replacement fibrosis, an independent risk factor for ventricular arrhythmias and sudden cardiac death. There are consensus documents and reviews on the use of cardiac magnetic resonance specifically in arrhythmic mitral valve prolapse. However, in this article, we propose an algorithm for the broader use of cardiac magnetic resonance in managing this condition in various scenarios. Future advancements may involve implementing techniques for tissue characterization and flow analysis, such as 4D flow imaging, to identify patients with ventricular dysfunction and remodeling, increased arrhythmic risk, and more accurate grading of mitral regurgitation, ultimately benefiting patient selection for surgical therapy.
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