208 | Chapter 10 Table 3. Characteristics of 8 subjects with MVP and/or MAD in the inferolateral wall on CMR Subject N=7 Sex MAD (mm) MVP (mm) Bi-leaflet MVP Curling sign MR* LGE ECG T-wave Abnormalities Ventricular ectopy AL ANT INF IL Control1 M 2 2 3 2 0 No No No n/a n/a n/a IVF 1 F 3 0 0 2 5 Yes No Moderate Basal septal LV Yes (inferior) No IVF 2 M3 0 53 3 No No Mild No No Yes (basal LV) IVF 3 M3 0 83 0 No No Mild No No No IVF 4 F3 3220 No Yes No No No Yes (RVOT) IVF 5 F 1 2 5 3 6 Yes Yes No No Yes (inferior) Yes (basal LV) IVF 6 M2 5120 No No No No Yes (inferior) Yes (RVOT) IVF 7 F 2 2 2 2 7 Yes Yes Mild No No Yes (LV apex) IVF 8 M0 0404 No No No No No Yes (RVOT) Abbreviations: AL = anterolateral wall, ANT = anterior wall, INF = inferior wall, IL = inferolateral wall, MAD = mitral annulus disjunction, MVP = mitral valve prolapse, CMR = cardiac magnetic resonance, ECG = electrocardiogram, LGE = late gadolinium enhancement, MR = mitral regurgitation. n/a = not available. MAD, MVP and the curling sign were assessed on CMR. * Mitral regurgitation was determined on echocardiography. Comparison between IVF patients with and without mitral valve disease Mitral regurgitation was more prevalent in patients with MAD and/or MVP compared to patients without (4 [50%] vs. 7 [14%], p=0.024) (Table 4). In addition, inverted or biphasic T-waves were more frequently observed in IVF patients with MAD/MVP compared to patients without (3 [38%] vs. 2 [3%], p=0.009). LGE imaging was available for analysis in the majority of IVF patients (n=61). In eight (13%) IVF patients, small LGE spots of uncertain pathogenicity were reported (Table 4). There was no difference in the occurrence of LGE between patients with MAD/MVP compared to patients without (1 [13%] vs. 7 [13%], p=1.000). One patient with inferolateral MAD showed midwall LGE in the LV basal inferoseptal myocardium (Figure S1) LGE was seen in seven patients without MAD: location and pattern of LGE ranged from small mid-wall or epicardial foci in 3 patients (basal inferolateral twice and basal inferior wall); three patients had a small subendocardial scar in the respectively basal inferior, apical septal and apical inferior segments, and one patient had a small transmural scar in the basal inferolateral segment. The patient with possible basal subendocardial LGE could also be slow flow in a basal crypt (Figure S1). The four patients with subendocardial to transmural LGE had no coronary artery disease on catheter angiography or coronary CT angiography.
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