Importance of Myocardial Fibrosis in Functional Mitral Regurgitation: From Outcomes to Decision-Making

Bernardo B C Lopes; Deborah H Kwon; Dipan J Shah; John R Lesser; Vinayak Bapat; Maurice Enriquez-Sarano; Paul Sorajja; João L Cavalcante

doi:10.1016/j.jcmg.2020.10.027

Importance of Myocardial Fibrosis in Functional Mitral Regurgitation: From Outcomes to Decision-Making

JACC Cardiovasc Imaging. 2021 Apr;14(4):867-878. doi: 10.1016/j.jcmg.2020.10.027. Epub 2021 Feb 10.

Authors

Bernardo B C Lopes¹, Deborah H Kwon², Dipan J Shah³, John R Lesser⁴, Vinayak Bapat⁴, Maurice Enriquez-Sarano⁴, Paul Sorajja⁴, João L Cavalcante⁵

Affiliations

¹ Cardiovascular Imaging Research Center and Core Lab, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA.
² Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA.
³ Houston Methodist Debakey Heart & Vascular Center, Houston, Texas, USA.
⁴ Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA; Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA.
⁵ Cardiovascular Imaging Research Center and Core Lab, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA; Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA; Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA. Electronic address: Joao.Cavalcante@allina.com.

PMID: 33582069
DOI: 10.1016/j.jcmg.2020.10.027

Abstract

Functional mitral regurgitation (FMR) is a common and complex valve disease, in which severity and risk stratification is still a conundrum. Although risk increases with FMR severity, it is modulated by subjacent left ventricular (LV) disease. The extent of LV remodeling and dysfunction is traditionally evaluated by echocardiography, but a growing body of evidence shows that myocardial fibrosis (MF) assessment by cardiac magnetic resonance (CMR) may complement risk stratification and inform treatment decisions. This review summarizes the current knowledge on the comprehensive evaluation that CMR can provide for patients with FMR, in particular for the assessment of MF and its potential impact in clinical decision-making.

Keywords: cardiac magnetic resonance; functional mitral regurgitation; myocardial fibrosis; secondary mitral regurgitation.

Publication types

Review

MeSH terms

Cardiomyopathies*
Fibrosis
Humans
Mitral Valve Insufficiency* / diagnostic imaging
Predictive Value of Tests
Ventricular Remodeling