Abstract 12912: Cardiovascular Magnetic Resonance Characterization of Rheumatic Mitral Stenosis: Findings From India, China, and Mexico

Abstract

Introduction: Cardiac remodeling in rheumatic mitral stenosis (MS) is incompletely understood. Cardiac magnetic resonance (CMR) imaging has the potential to provide more precise characterization of morphologic and functional changes that occur in response to MS. The objective of this study was to describe CMR findings in rheumatic MS to characterize cardiac structural and functional changes in this population. Methods: This retrospective study included 40 patients with rheumatic MS, including 15 patients from China, 19 patients from India, and 6 patients from Mexico. Patients were included in the rheumatic MS cohort if they did not have a prior mitral valve procedure, other concomitant moderate-severe or severe valve disease, or other known cardiovascular conditions. Twenty patients were included in the control group from India. CMR variables pertaining to morphology and function were collected. Late gadolinium enhancement (LGE) sequences were acquired for tissue characterization. Results: Forty patients with rheumatic MS (median (interquartile range (IQR)) age: 45 (34-55) years; 75% women) were studied. Compared to the control group, patients with MS had lower left ventricular (LV) ejection fraction (EF) (51% (42%-55%) vs 60% (57%-65%), p = 0.0001), lower right ventricular (RV) EF (44% (40%-52%) vs 64% (59%-67%), p < 0.0001), larger RV end-diastolic volumes (72 (58-87) mL/m 2 vs 59 (49-69) mL/m 2 , p = 0.003), and larger LA and RA sizes. LGE was prevalent in patients with MS, located at the RV insertion sites. Representative CMR images are shown in the Figure, with the arrows pointing to areas of LGE at the RV insertion sites. Conclusions: These findings further our understanding of the structural and functional changes that occur in response to rheumatic MS, and demonstrate that biventricular dysfunction is underappreciated in contemporary rheumatic MS. Further studies are required to understand the prognostic implications of these findings.