Abstract
Abstract Chronic mitral regurgitation (MR) is the second valvular heart disease for incidence, which worsening severity gradually affects all cardiac chambers and leads to poor outcome if untreated. The recent development of minimally invasive surgical techniques and percutaneous intervention has reduced the operative risk, allowing a more confident referral of these patients for intervention. Therefore, there is a growing need of reliable markers to select the best therapeutic strategies and to identify the optimal timing for intervention. Myocardial fibrosis (MF) gradually occurs as a result of left atrial and ventricular (LA and LV) remodeling due to MR pressure and volume overload. It has been identified as an index of clinical outcome and arrhythmic risk in patients with MR. Particularly, the assessment of LA fibrosis not only allows to define different MR etiology, but also was associated with prognosis and atrial fibrillation (AF) burden. Nowadays, noninvasive estimation of MF is possible through the use of advanced imaging modalities, particularly cardiac magnetic resonance and speckle tracking echocardiography. This review discusses the role of LA fibrosis as a diagnostic and prognostic marker in patients with MR and its quantification by noninvasive multimodality cardiac imaging.
Highlights
Chronic mitral regurgitation (MR) is the second most common valvular heart disease, due to primary or secondary etiology involving the mitral valve (MV). It is characterized by progressive worsening of severity and poor long-term prognosis if untreated, in terms of worse survival, quality of life and increased burden of atrial fibrillation (AF) and heart failure (HF) symptoms[1,2]
Kitkungvan et al studied the presence of Myocardial fibrosis (MF) detected by cardiac magnetic resonance (CMR) in 424 patients with primary MR (229 of whom with MV prolapse), founding that diffuse interstitial fibrosis was associated with MR severity, regardless of primary MR etiology, and that its extent was independently associated with symptoms related to MR and clinical events[26]
In another biopsy study conducted in a similar cohort we showed a stepwise reduction of global peak atrial longitudinal strain (PALS) and a close negative correlation between global and left atrial (LA) fibrosis grade which was superior to LA indexed volume, LA ejection fraction, and E/E’ ratio
Summary
Chronic mitral regurgitation (MR) is the second most common valvular heart disease, due to primary (organic) or secondary (functional e.g. post-ischemic or dilative cardiomyopathy) etiology involving the mitral valve (MV). This review aims to highlight the usefulness of left atrial (LA) fibrosis as a key element for diagnostic and prognostic evaluation in patients with MR and to provide information on its quantification by noninvasive multimodality cardiac imaging.
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
