TY - JOUR
T1 - Systematic quantification of histologic ventricular fibrosis in isolated mitral valve prolapse and sudden cardiac death
AU - Han, Hui Chen
AU - Parsons, Sarah A.
AU - Curl, Claire L.
AU - Teh, Andrew W.
AU - Raaijmakers, Antonia J.A.
AU - Koshy, Anoop N.
AU - Leong, Trishe
AU - Burrell, Louise M.
AU - O'Donnell, David
AU - Vohra, Jitendra K.
AU - Kalman, Jonathan M.
AU - Sanders, Prashanthan
AU - Hare, David L.
AU - Farouque, Omar
AU - Delbridge, Lea M.D.
AU - Lim, Han S.
PY - 2021/4
Y1 - 2021/4
N2 - Background: Cardiac fibrosis in mitral valve prolapse (MVP) is implicated in the development of sudden cardiac death (SCD); however, the pattern remains poorly characterized. Objective: The purpose of this study was to systematically quantify left and right ventricular fibrosis in individuals with isolated MVP and SCD (iMVP-SCD), whereby other potential causes of death are excluded, compared to a control cohort. Methods: Individuals with iMVP-SCD were identified from the Victorian Institute of Forensic Medicine, Australia, and matched for age, sex, and body mass index to control cases with noncardiac death. Cardiac tissue sections were analyzed to determine collagen deposition in the left ventricular free wall (anterior, lateral, and posterior portions), interventricular septum, and right ventricle. Within the iMVP-SCD cases, the endocardial-to-epicardial distribution of fibrosis within the left ventricle was specifically characterized. Results: Seventeen cases with iMVP-SCD were matched 1:1 with 17 controls, yielding 149 samples and 1788 histologic regions. The iMVP-SCD group had increased left ventricular (anterior, lateral, and posterior; all P <.001) and interventricular septum fibrosis (P <.001), but similar amounts of right ventricular fibrosis (P = .62) compared to controls. In iMVP-SCD, left ventricular fibrosis was significantly higher in the lateral and posterior walls compared to the anterior wall and interventricular septum (all P <.001). Within the lateral and posterior walls, iMVP-SCD cases had a significant endocardial-to-epicardial gradient of cardiac fibrosis (P <.01) similar to other known conditions that cause cardiac remodeling. Conclusion: Our study indicates that nonuniform left ventricular remodeling with both localized and generalized left ventricular fibrosis is important in the pathogenesis of SCD in individuals with MVP.
AB - Background: Cardiac fibrosis in mitral valve prolapse (MVP) is implicated in the development of sudden cardiac death (SCD); however, the pattern remains poorly characterized. Objective: The purpose of this study was to systematically quantify left and right ventricular fibrosis in individuals with isolated MVP and SCD (iMVP-SCD), whereby other potential causes of death are excluded, compared to a control cohort. Methods: Individuals with iMVP-SCD were identified from the Victorian Institute of Forensic Medicine, Australia, and matched for age, sex, and body mass index to control cases with noncardiac death. Cardiac tissue sections were analyzed to determine collagen deposition in the left ventricular free wall (anterior, lateral, and posterior portions), interventricular septum, and right ventricle. Within the iMVP-SCD cases, the endocardial-to-epicardial distribution of fibrosis within the left ventricle was specifically characterized. Results: Seventeen cases with iMVP-SCD were matched 1:1 with 17 controls, yielding 149 samples and 1788 histologic regions. The iMVP-SCD group had increased left ventricular (anterior, lateral, and posterior; all P <.001) and interventricular septum fibrosis (P <.001), but similar amounts of right ventricular fibrosis (P = .62) compared to controls. In iMVP-SCD, left ventricular fibrosis was significantly higher in the lateral and posterior walls compared to the anterior wall and interventricular septum (all P <.001). Within the lateral and posterior walls, iMVP-SCD cases had a significant endocardial-to-epicardial gradient of cardiac fibrosis (P <.01) similar to other known conditions that cause cardiac remodeling. Conclusion: Our study indicates that nonuniform left ventricular remodeling with both localized and generalized left ventricular fibrosis is important in the pathogenesis of SCD in individuals with MVP.
KW - Cardiac fibrosis
KW - Mitral valve disease
KW - Mitral valve prolapse
KW - Sudden death
KW - Valvular heart disease
UR - http://www.scopus.com/inward/record.url?scp=85100877293&partnerID=8YFLogxK
U2 - 10.1016/j.hrthm.2020.12.021
DO - 10.1016/j.hrthm.2020.12.021
M3 - Article
C2 - 33359875
AN - SCOPUS:85100877293
SN - 1547-5271
VL - 18
SP - 570
EP - 576
JO - Heart Rhythm
JF - Heart Rhythm
IS - 4
ER -