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

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.