# PET/MRI imaging of mitral valve prolapse

> **NIH NIH R01** · ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI · 2024 · $2,047,367

## Abstract

PROJECT SUMMARY
Mitral valve prolapse (MVP), identified in 1-3% of the general population, is the most common cardiac valvular
abnormality, with complications that include heart failure, ventricular arrhythmias and sudden cardiac death
(SCD). It has been estimated that the incidence of MVP-related SCD is 0.14% to 1.5% per year, depending on
the clinical characteristics of the population studied. While there have been multiple features identified as
markers of increased risk, left ventricular replacement fibrosis appears to be a consistent finding in Arrhythmic
MVP. Late gadolinium enhancement (LGE) by cardiac magnetic resonance imaging (MRI) is considered the
most sensitive and specific modality for assessing the presence and distribution of replacement fibrosis and it
has been strongly associated with increased incidence of arrhythmic events in patients with MVP. Preliminary
investigations from our group suggest that these fibrotic changes may be preceded by a chronic inflammatory
phase and that inflammation and scarring may be part of a continuum of ventricular transformation and directly
associated with arrhythmia development and complexity. We now propose an in-depth characterization of the
relationship between intensity and pattern of 18F-fluorodeoxyglucose (FDG) uptake on hybrid Positron Emission
Tomography (PET)/MRI, arrhythmia burden, severity of MVP and mitral regurgitation (MR). Detailed data
including patients’ baseline characteristics, echocardiographic features, histological and biomarker data,
arrhythmic burden and characterization will be obtained in patients with MVP, mild, moderate and severe MR, in
order to establish the correlation between the disease process in its various stages and the PET/MRI phenotype.
Specifically, in Aim 1 we will establish the inflammatory origin of the 18F-FDG signature in a cohort of patients
with MVP, severe MR and class I/II indications for mitral valve surgery. Histology and serum for biomarker
analysis will be collected at the time of surgery. Patients will additionally undergo a second imaging session with
a novel PET tracer, 68Ga-DOTATATE, more specific for inflammation. In Aim 2, patients with MVP, mild or
moderate MR, and a history of ventricular ectopy, who do not have an indication for surgery, will be enrolled into
a longitudinal observational clinical study. We will perform 18F-FDG PET/MRI imaging, echocardiography, 7-day
event monitoring (PVC burden and complexity) as well as collect circulating biomarkers at baseline and at follow-
up after 24 months. Lastly, in Aim 3, we will assess the impact of MV surgery on myocardial inflammation and
function, by repeating the same assessment as in Aim 2 but 12 months post-surgery to explore associations
between MV surgery and changes in myocardial inflammation. With this comprehensive approach, our ultimate
goal is the creation of a novel platform for the assessment of MVP, particularly as it relates to risk stratification
of ventricular arrhythmia...

## Key facts

- **NIH application ID:** 10914239
- **Project number:** 5R01HL166720-02
- **Recipient organization:** ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
- **Principal Investigator:** David H Adams
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $2,047,367
- **Award type:** 5
- **Project period:** 2023-08-25 → 2028-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10914239

## Citation

> US National Institutes of Health, RePORTER application 10914239, PET/MRI imaging of mitral valve prolapse (5R01HL166720-02). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10914239. Licensed CC0.

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