Histopathological insights into mitral valve prolapse-induced fibrosis

Frontiers in Cardiovascular Medicine

Cardiovascular Medicine

Robert A. Levine¹  Jordan Morningstar²  Russell A. Norris²  Serguei Melnitchouk³  Maja-Theresa Dieterlen⁴  Michael A. Borger⁴  Karoline Wiesner⁴  Kristin Klaeske⁴  Ricardo Spampinato⁴  Mateo Marin-Cuartas⁴  Antonia van Kampen⁵ 

[1] Cardiac Ultrasound Laboratory, Harvard Medical School, Massachusetts General Hospital, Boston, MA, United States;Department of Regenerative Medicine and Cell Biology, Medical University of South Carolina, Charleston, SC, United States;Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States;University Department of Cardiac Surgery, Heart Center Leipzig, HELIOS Clinic, Leipzig, Germany;University Department of Cardiac Surgery, Heart Center Leipzig, HELIOS Clinic, Leipzig, Germany;Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States;

关键词: mitral valve;    fibrosis;    mitral valve prolapse;    histology;    collagen;   

DOI  :  10.3389/fcvm.2023.1057986

 received in 2022-09-30, accepted in 2023-02-16,  发布年份 2023

来源: Frontiers

【 摘 要 】

Mitral valve prolapse (MVP) is a cardiac valve disease that not only affects the mitral valve (MV), provoking mitral regurgitation, but also leads to maladaptive structural changes in the heart. Such structural changes include the formation of left ventricular (LV) regionalized fibrosis, especially affecting the papillary muscles and inferobasal LV wall. The occurrence of regional fibrosis in MVP patients is hypothesized to be a consequence of increased mechanical stress on the papillary muscles and surrounding myocardium during systole and altered mitral annular motion. These mechanisms appear to induce fibrosis in valve-linked regions, independent of volume-overload remodeling effects of mitral regurgitation. In clinical practice, quantification of myocardial fibrosis is performed with cardiovascular magnetic resonance (CMR) imaging, even though CMR has sensitivity limitations in detecting myocardial fibrosis, especially in detecting interstitial fibrosis. Regional LV fibrosis is clinically relevant because even in the absence of mitral regurgitation, it has been associated with ventricular arrhythmias and sudden cardiac death in MVP patients. Myocardial fibrosis may also be associated with LV dysfunction following MV surgery. The current article provides an overview of current histopathological studies investigating LV fibrosis and remodeling in MVP patients. In addition, we elucidate the ability of histopathological studies to quantify fibrotic remodeling in MVP and gain deeper understanding of the pathophysiological processes. Furthermore, molecular changes such as alterations in collagen expression in MVP patients are reviewed.

【 授权许可】

Unknown   
© 2023 Dieterlen, Klaeske, Spampinato, Marin-Cuartas, Wiesner, Morningstar, Norris, Melnitchouk, Levine, van Kampen and Borger.