Patients with mitral valve insufficiency frequently suffer from left atrial remodeling,
caused by volume overload and subsequent atrial dilatation. The associated myocardial
stretch and increased wall tension, trigger a cascade of pathways leading to the
occurrence of atrial fibrosis as part of the remodeling process. The clinical relevance
of this atrial fibrosis, is that its presence is associated with an increased risk of
atrial fibrillation, heart failure, pulmonary hypertension, a reduced quality of life and
eventually a shorter life expectancy. In addition, in patients suffering from atrial
fibrillation, the presence and amount of left atrial fibrosis was found to be a strong
predictor for ablation efficacy and long-term outcome.
In daily clinical practice, mitral valve insufficiency is managed either by medical or
surgical therapy. However, since medical therapy is often not sufficient for patients
with severe primary mitral valve insufficiency, surgical intervention remains the
ultimate treatment option for these patients. In general, valve repair is the preferred
type of surgery, since it has better clinical results compared to valve replacement.
Currently, the indication and timing for valve surgery is mainly based on the severity of
mitral valve insufficiency and the presence of symptoms and/or severity of left
ventricular dysfunction. For clinical decision making and patient stratification for
mitral valve surgery, the presence of atrial fibrosis is currently not taken in account,
despite its well-recognized clinical implications.
Detection of atrial fibrosis patterns in patients with severe mitral valve insufficiency,
however, may be potentially valuable for the indication and timing of mitral valve repair
surgery to improve clinical outcomes. Improved insight into atrial fibrosis patterns and
changes after mitral valve repair due to reverse remodeling, may help clinicians in their
clinical decision making and timing for surgery.
Today, quantification of atrial fibrosis can be routinely performed using cardiac
Magnetic Resonance Imaging (MRI) techniques and advanced post-processing tools, offering
non-invasive tissue characterization in thin-walled structures.
To date, mitral valve insufficiency patients suffering from left atrial remodeling have
hardly been studied using these new imaging techniques. Therefore, in this study, the
investigators want to combine advanced cardiac MRI and post-processing techniques prior
to and after mitral valve repair surgery to gain insight on the clinical role and
predictive value of atrial fibrosis in this patient population.
In addition, the investigators aim to assess the effects of (reduced) volume overload on
atrial wall texture, geometry and function.
It is hypothesized that the atrial fibrosis surface area paradoxically will increase
after mitral valve surgery because of global shrinkage of the left atrium caused by the
reversed remodeling process. As a consequence, more frequently atrial fibrosis related
events including (paroxysmal) atrial fibrillation, may be observed in these patients.
With this insight, cardiac MRI can become clinical valuable for the indication and timing
of surgical intervention in these patients. Surgical therapy might be renounced for
example when a substantial increase of fibrosis surface is expected post-surgically
causing a higher risk for atrial fibrillation, heart failure, pulmonary hypertension and
a reduced quality of life. On the contrary, surgical therapy might be considered in an
earlier stage of disease when the amount of fibrosis is still limited regarding its
expected post-surgical development.