Myocardial Characterization of Arrhythmogenic Mitral Valve Prolapse (STAMP: STretch and Myocardial Characterization in Arrhythmogenic Mitral Valve Prolapse)
Myocardial Characterization of Arrhythmogenic Mitral Valve Prolapse (STAMP: STretch and Myocardial Characterization in Arrhythmogenic Mitral Valve Prolapse)
Mitral valve prolapse (MVP) is a frequent affection of the mitral valve or its sub-valvular
 apparatus with a prevalence of 2-3% in the general population. This valvular disease is
 generally considered as benign, but may at term evolve toward mitral valve regurgitation of
 various severity and/or arrhythmia.

 Mitral valve prolapse is routinely diagnosed using transthoracic echocardiography and only
 patients with significant mitral regurgitation will undergo subsequent examination (24-hour
 external loop recording, exercise ECG, cardiac MRI) and a close follow-up.

 External loop recording and exercise ECG have an interest in the identification of patients
 presenting with arrhythmic complications, such as premature ventricular contractions, and in
 the global evaluation of hemodynamic consequences of the mitral regurgitation.

 More recently, detection of myocardial fibrosis among patients with MVP and severe
 ventricular arrhythmia has been identified. Fibrosis could evolve independently of the
 valvular regurgitation's severity and could be a substrate (myocardial scar) leading to
 ventricular arrhythmia. However, no study has specifically characterized myocardial lesions
 among patients with MVP and none, or not significant, mitral regurgitation. Using cardiac
 magnetic resonance imaging (MRI), gold standard technique in myocardial imaging and
 characterization, and echocardiography, particularly speckle-tracking imaging, identification
 of static (fibrosis) and/or dynamic (ventricular systolic deformation patterns using
 speckle-tracking strain) myocardial lesions.

 Identification of patients with impaired deformation patterns, fibrosis or with premature
 ventricular contractions may isolate a sub-group of patients with a higher risk of severe
 ventricular arrhythmia for whom a closer follow-up could be justified.
Inclusion Criteria:

 -  Mitral valve prolapse diagnosed in echocardiography

 -  Signed written consent

 -  Affiliation to social security

 -  No contraindication to MRI or exercise ECG

 -  Age above 18

 Exclusion Criteria:

 -  Mitral valve prolapse with severe regurgitation and instable hemodynamic state
 requiring urgent surgery

 -  Prior MRI with contrast within the last month

 -  Prior diagnosis of primary cardiomyopathy potentially responsible for myocardial
 fibrosis

 -  Contraindication to exercise ECG: severe handicap, poor physical capacity

 -  Contraindication to MRI: implantable device, claustrophobia, metal debris

 -  Renal insufficiency with creatinine clearance <30 ml/min or prior serious side effect
 related to infusion of a magnetic contrast agent

 -  Pregnant or breast-feeding women

 -  Minors <18 years old

 -  Mental illness or incapacity with incapacity to obtain informed consent