Left Ventricular Remodelling and Functional Status Across Mitral Regurgitation Severity in Mitral Valve Prolapse
- 1Karolinska Institutet
Abstract
BackgroundMitral valve prolapse (MVP) causes mitral regurgitation (MR), leading to volume overload and maladaptive left ventricular (LV) remodelling.
ObjectiveTo comprehensively characterize markers of maladaptive LV remodelling across MR severity grades in MVP using cardiovascular magnetic resonance (CMR), and their association with functional status.
MethodsPatients with MVP undergoing 1.5T CMR (2016-2025) were stratified by MR fraction: mild<20%, moderate 20-39%, and severe [≥]40%. Exclusion criteria were significant coronary artery disease, rheumatic valve disease, mitral stenosis, previous mitral valve procedures, endocarditis or signs of primary cardiomyopathy. Global native T1, T2, extracellular volume (ECV), indexed ECV (iECV), indexed intracellular volume (iICV), and late gadolinium enhancement (LGE) were quantified. Indexed LV end-diastolic volume (EDVI) and the EDV-to-LV mass ratio (EDV/LVM-ratio) were also calculated as indices of LV remodelling and adaptive hypertrophy. Functional status was assessed by NYHA class.
ResultsAmong 112 MVP patients (23 mild, 48 moderate, 41 severe MR) and 20 controls, LGE prevalence (17% vs. 46% vs. 51% vs. 0%) and the proportion with LV dilatation (46% vs. 67% vs. 88% vs 15%) rose progressively with MR severity. Increased EDVI, prevalence of LGE, higher EDV/LVM-ratio, global native T1 and iECV showed the strongest associations with more severe MR, whereas EDV/LVM-ratio, iECV and global native T1 were independently related to NYHA class[≥]II.
ConclusionsCMR markers of maladaptive LV remodelling were abnormal across all MR grades and increased markedly with MR severity. Global native T1, iECV and EDV/LVM-ratio correlated most strongly with symptom burden, rather than MR severity per se.
Clinical Trial RegistrationNCT06255457
O_FIG O_LINKSMALLFIG WIDTH=200 HEIGHT=145 SRC="FIGDIR/small/26364239v1_ufig1.gif" ALT="Figure 1"> View larger version (44K): [email protected]@16acd4aorg.highwire.dtl.DTLVardef@cbe322org.highwire.dtl.DTLVardef@1ad080f_HPS_FORMAT_FIGEXP M_FIG C_FIG
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BibTeX
@misc{lodin2026left,
title = {{Left Ventricular Remodelling and Functional Status Across Mitral Regurgitation Severity in Mitral Valve Prolapse}},
author = {K. Lodin and C. Oliveira Da Silva and A. Wang and I. Bulatovic and L. Ostergaard and G. Boano and A. Manouras and L. H. Lund and P. Svenarud and M. Dalen and M. Carlsson and J. Nickander and B. Shahim},
howpublished = {medRxiv},
year = {2026},
month = sep,
doi = {10.64898/2026.09.28.26364239},
url = {https://www.medrxiv.org/content/10.64898/2026.09.28.26364239v1},
note = {CC BY-NC-ND},
}
RIS
TY - UNPB
TI - Left Ventricular Remodelling and Functional Status Across Mitral Regurgitation Severity in Mitral Valve Prolapse
AU - K. Lodin
AU - C. Oliveira Da Silva
AU - A. Wang
AU - I. Bulatovic
AU - L. Ostergaard
AU - G. Boano
AU - A. Manouras
AU - L. H. Lund
AU - P. Svenarud
AU - M. Dalen
AU - M. Carlsson
AU - J. Nickander
AU - B. Shahim
PY - 2026
DA - 2026/09/28
PB - medRxiv
DO - 10.64898/2026.09.28.26364239
UR - https://www.medrxiv.org/content/10.64898/2026.09.28.26364239v1
AB - BackgroundMitral valve prolapse (MVP) causes mitral regurgitation (MR), leading to volume overload and maladaptive left ventricular (LV) remodelling. ObjectiveTo comprehensively characterize markers of maladaptive LV remodelling across MR severity grades in MVP using cardiovascular magnetic resonance (CMR), and their association with functional status. MethodsPatients with MVP undergoing 1.5T CMR (2016-2025) were stratified by MR fraction: mild<20%, moderate 20-39%, and severe [≥]40%. Exclusion criteria were significant coronary artery disease, rheumatic valve disease, mitral stenosis, previous mitral valve procedures, endocarditis or signs of primary cardiomyopathy. Global native T1, T2, extracellular volume (ECV), indexed ECV (iECV), indexed intracellular volume (iICV), and late gadolinium enhancement (LGE) were quantified. Indexed LV end-diastolic volume (EDVI) and the EDV-to-LV mass ratio (EDV/LVM-ratio) were also calculated as indices of LV remodelling and adaptive hypertrophy. Functional status was assessed by NYHA class. ResultsAmong 112 MVP patients (23 mild, 48 moderate, 41 severe MR) and 20 controls, LGE prevalence (17% vs. 46% vs. 51% vs. 0%) and the proportion with LV dilatation (46% vs. 67% vs. 88% vs 15%) rose progressively with MR severity. Increased EDVI, prevalence of LGE, higher EDV/LVM-ratio, global native T1 and iECV showed the strongest associations with more severe MR, whereas EDV/LVM-ratio, iECV and global native T1 were independently related to NYHA class[≥]II. ConclusionsCMR markers of maladaptive LV remodelling were abnormal across all MR grades and increased markedly with MR severity. Global native T1, iECV and EDV/LVM-ratio correlated most strongly with symptom burden, rather than MR severity per se. Clinical Trial RegistrationNCT06255457 O_FIG O_LINKSMALLFIG WIDTH=200 HEIGHT=145 SRC="FIGDIR/small/26364239v1_ufig1.gif" ALT="Figure 1"> View larger version (44K): [email protected]@16acd4aorg.highwire.dtl.DTLVardef@cbe322org.highwire.dtl.DTLVardef@1ad080f_HPS_FORMAT_FIGEXP M_FIG C_FIG
ER -