Because progression of LA remodeling due to prolonged presence of MR is associated with worse outcomes, including increased cardiovascular morbidity and mortality ( 23– 26), timing of surgical intervention is crucial to avoid severe LA remodeling.Ĭurrently, the indication and timing for MVR in these patients is mainly based on severity of MR and the presence of symptoms or left ventricular dysfunction (end systolic dimension ≥ 4.0 cm or left ventricular ejection fraction ≤ 60%) ( 27). ![]() In current clinical practice, mitral valve repair (MVR) surgery is the ultimate treatment for primary MR ( 21, 22). This may be important, since presence and distribution of LA fibrosis in primary MR patients may have clinical implications for patient-specific treatment strategies. Extent and geometric distribution of LA fibrosis can be assessed using advanced post-processing tools, allowing to study LA fibrosis in primary MR patients on a routine base. In the last decade, high spatial resolution 3-dimensional (3D) late gadolinium enhanced (LGE) cardiac magnetic resonance (CMR) imaging has emerged as a noninvasive tool for the visualization and quantification of LA fibrosis ( 18– 20). Several studies have suggested that LA fibrosis may also be present in MR patients, but its role and consequences remain yet to be determined ( 1, 2, 11, 14– 17). In addition, presence and amount of LA fibrosis was found to be a strong predictor for arrhythmic treatment efficacy and long-term outcome in patients suffering from AF ( 12, 13). In different categories of patients without primary MR, it has been demonstrated that the presence of atrial fibrosis is associated with an increased risk of adverse events including atrial fibrillation (AF), stroke, heart failure, pulmonary hypertension, reduced quality of life and eventually a shorter life expectancy ( 8– 11). Our results may contribute to improved clinical decision making and patient-specific treatment strategies in patients suffering from MR. ![]() Implications: This study will provide novel insights into the pathophysiological mechanism of fibrotic and volumetric atrial (reversed) remodeling in MR patients undergoing MVR surgery. ![]() The primary objective of the ALIVE trial is to assess the extent and geometric distribution of LA fibrosis in MR patients and to determine effects of MVR surgery on reversed atrial remodelling. In total, 20 participants will undergo a CMR scan including 3D late gadolinium enhancement (LGE) imaging 2 week prior to MVR surgery and at 3 months follow-up. Methods: The ALIVE trial is a single center, prospective pilot study investigating LA fibrosis in patients suffering from MR in the absence of AF (identifier NCT05345730). Therefore, the ALIVE trial was designed to investigate the presence of LA remodeling including LA fibrosis in MR patients prior to and after mitral valve repair (MVR) surgery. Literature on the presence and extent of LA fibrosis in MR patients however, is scarce and its clinical implications remain unknown. LA fibrosis is considered to be a key player in the LA remodeling process, as observed in atrial fibrillation (AF) patients.
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