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Cardiac magnetic resonance imaging in the evaluation and management of mitral valve prolapse.
  • +13
  • Francesco Mangini,
  • Maria Scarcia,
  • Robert Biederman,
  • Roberto Calbi,
  • Francesco Spinelli,
  • Grazia Casavecchia,
  • Matteo Gravina,
  • Natale Daniele Brunetti,
  • Corrado Fiore,
  • Sergio Suma,
  • Maria Milo,
  • Cristiano Turchetti,
  • Ernesto Pesce,
  • Remo Caramia,
  • Francesca Lombardi,
  • Massimo Grimaldi
Francesco Mangini
Ospedale Generale Regionale F Miulli

Corresponding Author:[email protected]

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Maria Scarcia
Ospedale Generale Regionale F Miulli
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Robert Biederman
Roper St Francis Healthcare
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Roberto Calbi
Ospedale Generale Regionale F Miulli
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Francesco Spinelli
Ospedale Generale Regionale F Miulli
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Grazia Casavecchia
University of Foggia
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Matteo Gravina
University of Foggia
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Natale Daniele Brunetti
University of Foggia
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Corrado Fiore
Citta di Lecce Hospital
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Sergio Suma
Azienda Ospedaliero Universitaria di Parma
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Maria Milo
ASL Brindisi
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Cristiano Turchetti
Madonna della Bruna - Outpatients clinic
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Ernesto Pesce
Madonna della Bruna - Outpatients clinic
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Remo Caramia
ASL Brindisi
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Francesca Lombardi
Universita Cattolica del Sacro Cuore
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Massimo Grimaldi
Ospedale Generale Regionale F Miulli
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Abstract

Mitral valve prolapse is a common valve disorder that usually has a benign prognosis unless there is significant regurgitation or left ventricular 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-MR 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.
07 Jun 2024Submitted to Echocardiography
13 Jun 2024Reviewer(s) Assigned
21 Jun 2024Review(s) Completed, Editorial Evaluation Pending
01 Jul 20241st Revision Received
05 Jul 2024Review(s) Completed, Editorial Evaluation Pending
05 Jul 2024Editorial Decision: Accept