Effect of Myocardial Fibrosis on Left Ventricular Function in Rheumatic Mitral Stenosis: A Preliminary Study with Cardiac Magnetic Resonance

Abstract

Introduction

Myocardial fibrosis is an increasingly recognized complication in rheumatic mitral stenosis (MS) that adversely affects left ventricular (LV) function. This review synthesizes the evidence on the interplay between myocardial fibrosis and LV dysfunction in MS, highlighting the critical diagnostic and prognostic role of cardiac magnetic resonance (CMR).

Methods

This abstract is based on a literature review synthesizing findings from clinical studies, systematic reviews, and meta-analyses. The review examined the impact of myocardial fibrosis on LV function in patients with rheumatic MS and evaluated the utility of advanced imaging, particularly CMR, for its assessment.

Results

Myocardial fibrosis, driven by pressure overload and inflammation, impairs LV function by increasing ventricular wall stiffness and causing diastolic dysfunction. CMR with Late Gadolinium Enhancement (LGE) is a principal tool for identifying and quantifying focal fibrosis. The presence and extent of fibrosis detected by LGE are strong predictors of adverse outcomes, including all-cause mortality, even post-surgery. Advanced CMR techniques also show that impaired LV mechanical deformation correlates directly with the degree of myocardial fibrosis.

Discussion

The evidence refutes the traditional notion that the LV is unaffected in rheumatic MS, identifying myocardial fibrosis as a key driver of LV dysfunction. CMR provides crucial non-invasive prognostic information that can guide clinical decision-making. However, the absence of standardized, disease-specific cut-off values for imaging parameters currently limits its widespread clinical application in management algorithms.

Conclusion

Myocardial fibrosis has a significant detrimental effect on LV function in rheumatic mitral stenosis. Advanced imaging with CMR is essential for detecting fibrosis, stratifying patient risk, and guiding therapy. Future research should focus on establishing standardized imaging protocols and investigating targeted anti-fibrotic treatments.