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. 2022 Apr 7;24(1):24.
doi: 10.1186/s12968-022-00853-5.

Cardiovascular magnetic resonance characterization of rheumatic mitral stenosis: findings from three worldwide endemic zones

Mahesh K Vidula  1 , Ziqian Xu  2 , Yuanwei Xu  3 , Abdullah Alturki  4 , Bhavana N Reddy  5 , Prayaag Kini  6 , Angel L Alberto-Delgado  7 , Ron Jacob  8 , Tiffany Chen  1 , Victor A Ferrari  1 , Lilia M Sierra-Galan  9 , Yucheng Chen  3 , Sanjaya Viswamitra  5 , Yuchi Han  10   11   12
Affiliations

Cardiovascular magnetic resonance characterization of rheumatic mitral stenosis: findings from three worldwide endemic zones

Mahesh K Vidula et al. J Cardiovasc Magn Reson. .

Abstract

Background: Cardiac remodeling in rheumatic mitral stenosis (MS) is complex and incompletely understood. The objective of this study was to evaluate cardiac structural and functional changes in a cohort of patients with rheumatic MS using cardiovascular magnetic resonance (CMR).

Methods: This retrospective study included 40 patients with rheumatic MS, consisting of 19 patients from India, 15 patients from China, and 6 patients from Mexico (median (interquartile range (IQR)) age: 45 years (34-55); 75% women). Twenty patients were included in the control group. CMR variables pertaining to morphology and function were collected. Late gadolinium enhancement (LGE) sequences were acquired for tissue characterization. Statistical analyses were performed using the Kruskal-Wallis test and the chi-square test.

Results: Compared to the control group, patients with MS had lower left ventricular (LV) ejection fraction (51% (42%-55%) vs 60% (57%-65%), p < 0.001), lower right ventricular (RV) ejection fraction (44% (40%-52%) vs 64% (59%-67%), p < 0.001), higher RV end-diastolic volume (72 (58-87) mL/m2 vs 59 (49-69) mL/m2, p = 0.003), larger left atrial volume (87 (67-108) mL/m2 vs 29 (22-34) mL/m2, p < 0.001), and right atrial areas (20 (16-23) cm2 vs 13 (12-16) cm2, p < 0.001). LGE was prevalent in patients with rheumatic MS (82%), and was commonly located at the RV insertion sites. Furthermore, the patient cohorts from India, China, and Mexico were heterogeneous in terms of baseline characteristics and cardiac remodeling.

Conclusion: Our findings demonstrated that biventricular dysfunction, right and left atrial remodeling, and LGE at the RV insertion sites are underappreciated in contemporary rheumatic MS. Further studies are needed to elucidate the prognostic implications of these findings.

Keywords: Cardiac remodeling; Cardiovascular magnetic resonance; Rheumatic mitral stenosis.

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Conflict of interest statement

None.

Figures

Fig. 1
Fig. 1
Flow diagram of patients included in the analysis. AS, aortic stenosis; MI, myocardial infarction; MR, mitral regurgitation; TR, tricuspid regurgitation
Fig. 2
Fig. 2
Representative examples of cardiovascular magnetic resonance images of patients with rheumatic mitral stenosis from India, China, and Mexico. White arrows point to regions of late gadolinium enhancement (LGE) at the right ventricular (RV) insertion sites
Fig. 3
Fig. 3
Endomyocardial biopsy from a mitral stenosis patient in Mexico. Biopsy was performed at the area of LGE involving the RV insertion site and revealed myocardial fibrosis, demonstrating correlation between LGE and histology
See this image and copyright information in PMC

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