T1 mapping and cardiac magnetic resonance feature tracking in mitral valve prolapse



T1 mapping (T1-map) and cardiac magnetic resonance feature tracking (CMR-FT) techniques have been introduced for the early detection of interstitial myocardial fibrosis and deformation abnormalities. We sought to demonstrate that T1-map and CMR-FT may identify the presence of subclinical myocardial structural changes in patients with mitral valve prolapse (MVP).


Consecutive MVP patients with moderate-to-severe mitral regurgitation and comparative matched healthy subjects were prospectively enrolled and underwent CMR-FT analysis to calculate 2D global and segmental circumferential (CS) and radial strain (RS) and T1-map to determine global and segmental native T1 (nT1) values.


Seventy-three MVP patients (mean age, 57 ± 13 years old; male, 76%; regurgitant volume, 57 ± 21 mL) and 42 matched control subjects (mean age, 56 ± 18 years; male, 74%) were included. MVP patients showed a lower global CS (− 16.3 ± 3.4% vs. − 17.8 ± 1.9%, p = 0.020) and longer global nT1 (1124.9 ± 97.7 ms vs. 1007.4 ± 26.1 ms, p < 0.001) as compared to controls. Moreover, MVP patients showed lower RS and CS in basal (21.6 ± 12.3% vs. 27.6 ± 8.9%, p = 0.008, and − 13.0 ± 6.7% vs. − 14.9 ± 4.1%, p = 0.013) and mid-inferolateral (20.6 ± 10.7% vs. 28.4 ± 8.7%, p < 0.001, and − 12.8 ± 6.3% vs. − 16.5 ± 4.0%, p < 0.001) walls as compared to other myocardial segments. Similarly, MVP patients showed longer nT1 values in basal (1080 ± 68 ms vs. 1043 ± 43 ms, p < 0.001) and mid-inferolateral (1080 ± 77 ms vs. 1034 ± 37 ms, p < 0.001) walls as compared to other myocardial segments. Of note, nT1 values were significantly correlated with CS (r, 0.36; p < 0.001) and RS (r, 0.37; p < 0.001) but not with regurgitant volume.


T1-map and CMR-FT identify subclinical left ventricle tissue changes in patients with MVP. Further studies are required to correlate these subclinical tissue changes with the outcome.

Key Points

T1 mapping (T1-map) and cardiac magnetic resonance feature tracking (CMR-FT) techniques have been introduced for the early detection of interstitial myocardial fibrosis and deformation abnormalities.

In MVP patients, we demonstrated a longer global nT1 with associated reduced global circumferential (CS) and radial strain (RS) as compared to control subjects.

Among MVP patients, the mid-basal left ventricle inferolateral wall showed longer nT1 with reduced CS and RS as compared to other myocardial segments. Further studies are required to correlate these subclinical tissue changes with the outcome.

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Cardiac magnetic resonance


Circumferential strain


Feature tracking


Longitudinal strain


Left ventricle


Mitral annular disjunction


Mitral regurgitation


Mitral valve prolapse


Native T1 value


Radial strain


Sudden cardiac death


T1 mapping


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The authors state that this work has not received any funding.

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Corresponding author

Correspondence to Gianluca Pontone.

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The scientific guarantor of this publication is Gianluca Pontone.

Conflict of interest

Gianluca Pontone declares institutional research grant and/or honorarium as speaker from General Electric, Bracco, Medtronic, Bayer, and Heartflow. Daniele Andreini declares institutional research grant and/or honorarium as speaker from General Electric, Bracco, and Heartflow. The other authors have no disclosure.

Statistics and biometry

One of the authors (Laura Fusini) has significant statistical expertise.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

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Institutional Review Board approval was obtained.


• Prospective, observational study

• performed at one institution

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Figure S1

Dot plot of radial strain (Upper Row), circumferential strain (Middle row) and native T1 values (Lower row) of the basal (left panel) and mid (right panel) inferolateral segments of the left ventricle versus other segments in MVP patients and controls. MVP: mitral valve prolapse; *:p < 0.05 MVP patients vs. control subjects (PPTX 132 kb)

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Guglielmo, M., Fusini, L., Muscogiuri, G. et al. T1 mapping and cardiac magnetic resonance feature tracking in mitral valve prolapse. Eur Radiol 31, 1100–1109 (2021). https://doi.org/10.1007/s00330-020-07140-w

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  • Magnetic resonance imaging
  • Mitral valve prolapse
  • Heart valves
  • Feature tracking
  • Mapping