Comprehensive mitral valve prolapse assessment by cardiovascular MRI

Highlights: • Cardiac magnetic resonance has a key role in diagnosis of mitral valve prolapse. • Mitral valve prolapse may be associated to arrhythmias and sudden death. • Mitral annular disjunction is associated with incidence of arrhythmic events. • CMRI is the gold standard method for quantification of mitral valve regurgitation. Mitral valve (MV) prolapse (MVP) is a not fully understood common MV disorder. The development of sophisticated cardiovascular magnetic resonance imaging (CMRI) sequences over the last decades has allowed a more detailed assessment and provided better understanding of the pathophysiology of MVP to guide management, interventions, and risk stratification of patients affected. This review provides an overview of the most recent insights about this multifaceted pathology, particularly regarding the emerging concepts of mitral annular disjunction (MAD), and risk of arrhythmia and sudden death associated with myocardial fibrosis. We describe the emerging role of CMRI in both diagnosis and, more importantly, risk assessment of this disease, aiming to provide a comprehensive protocol for the assessment of MVP, which could represent a practical guide to clinicians and MRI practitioners working in the field.