|
1
|
Cristin L, Tastet L, Shah DJ, Miller MA, Delling FN. Multimodality Imaging of Arrhythmic Risk in Mitral Valve Prolapse. Circ Cardiovasc Imaging 2025; 18:e017313. [PMID: 40207354 DOI: 10.1161/circimaging.124.017313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/11/2025]
Abstract
Mitral valve prolapse (MVP) affects 2% to 3% of the general population and is typically benign. However, a subset of patients may develop arrhythmic complications, including sudden cardiac arrest and sudden cardiac death. This review explores the critical role of multimodality imaging in risk stratification for arrhythmic MVP, emphasizing high-risk features such as bileaflet involvement, mitral annular disjunction, the double-peak strain pattern, mechanical dispersion, and myocardial fibrosis. Echocardiography remains the first-line imaging tool for MVP diagnosis, enabling detailed assessment of leaflet morphology, mitral annular disjunction, and mitral regurgitation quantification. Speckle tracking provides insights into abnormal valvular-myocardial mechanics as a potential arrhythmogenic mechanism in MVP. Cardiac magnetic resonance (CMR) offers detailed myocardial tissue characterization through assessment of replacement and interstitial fibrosis using late gadolinium enhancement and T1 mapping/extracellular volume fraction, respectively. Hybrid positron emission tomography/CMR highlights the role of inflammation, which may coexist with fibrosis, in explaining the presence of malignant arrhythmias even with relatively limited fibrosis. The assessment of diffuse fibrosis and inflammation by CMR and positron emission tomography/CMR is particularly valuable in patients without classic imaging risk factors such as mitral annular disjunction, severe mitral regurgitation, or replacement fibrosis. We propose an algorithm integrating clinical, rhythmic, echocardiographic, CMR, and positron emission tomography/CMR parameters for arrhythmic risk stratification and management. Although multimodality imaging is essential for comprehensive risk assessment, most available parameters have not yet been validated in prospective studies nor linked directly to mortality. Consequently, these imaging findings should be interpreted alongside the presence of complex ventricular ectopy, which remains the most robust predictor of mortality in arrhythmic MVP.
Collapse
Affiliation(s)
- Luca Cristin
- Department of Medicine (Cardiovascular Division), University of California, San Francisco (L.C., L.T., F.N.D.)
| | - Lionel Tastet
- Department of Medicine (Cardiovascular Division), University of California, San Francisco (L.C., L.T., F.N.D.)
| | - Dipan J Shah
- Department of Cardiology, Houston Methodist, Weill Cornell Medical College, Houston, TX (D.J.S.)
| | - Marc A Miller
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, NY (M.A.M.)
| | - Francesca N Delling
- Department of Medicine (Cardiovascular Division), University of California, San Francisco (L.C., L.T., F.N.D.)
| |
Collapse
|
|
2
|
Kang J, van Kampen A, Dieterlen MT, Spampinato R, Sundt T, Melnitchouk S, Levine RA, Borger MA. Arrhythmic Mitral Valve Prolapse: Pathophysiology, Diagnostics, and Management Strategies. Semin Thorac Cardiovasc Surg 2025:S1043-0679(25)00042-5. [PMID: 40189179 DOI: 10.1053/j.semtcvs.2025.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2024] [Revised: 03/07/2025] [Accepted: 03/17/2025] [Indexed: 04/24/2025]
Abstract
Mitral valve prolapse (MVP) is a common disease in which ventricular arrhythmias/sudden cardiac death can be the first symptom of presentation. This review article explores the current understanding of underlying pathological mechanisms leading to an increased risk for ventricular arrhythmias in the setting of MVP and elaborates on the current evidence regarding the diagnosis and management of the disease.
Collapse
Affiliation(s)
- Jagdip Kang
- University Department of Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany; Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Antonia van Kampen
- University Department of Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany
| | | | - Ricardo Spampinato
- University Department of Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany
| | - Thoralf Sundt
- Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Serguei Melnitchouk
- Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Robert A Levine
- Cardiac Ultrasound Laboratory, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts
| | - Michael A Borger
- University Department of Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany.
| |
Collapse
|
|
3
|
Pasta S, La Franca E, Crascì F, Gentile G, Cipriani M, Faletra FF. Shape of the mitral annulus in normal individuals and dilated cardiomyopathies: computational modeling insights into leaflet stress distribution. Front Physiol 2025; 16:1532972. [PMID: 40200983 PMCID: PMC11976255 DOI: 10.3389/fphys.2025.1532972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2024] [Accepted: 03/07/2025] [Indexed: 04/10/2025] Open
Abstract
Introduction: The mitral valve annulus naturally adopts a saddle shape in systole, likely concentrating systolic stress on the commissures where fibrous trigones are located. This study hypothesized that in patients with dilated cardiomyopathies, where the annulus is large and planar, the stress would be redirected. Methods: Computational modeling was employed to compare the stress distribution in saddle-shaped mitral valves (n.10 patients) with planar annuli seen in dilated cardiomyopathy (n.10 patients) using kinematics of the mitral valve annulus from systole to diastole extrapolated from computed tomography angiography. Results: Simulations revealed high stress near the anterolateral and posteromedial commissures in normal valves, in contrast to high leaflet stress in planar annuli. Significant differences in stress distribution were observed near the anterolateral (S = 0.427 ± 0.053 MPa in normal valves vs S = 0.211 ± 0.123 MPa in diseased valves, p < 0.001) and posterolateral commissures (S = 0.340 ± 0.008 MPa in normal valves vs S = 0.208 ± 0.060 MPa in diseased valves, p < 0.001). Additionally, mitral annulus disjunction was present in healthy patients but absent in those with annulus planarity due to dilated cardiomyopathy. Discussion: This study suggests that while the saddle-shaped annulus focuses leaflet stress on commissures, planar annuli distribute systolic stress over leaflet surfaces. This may trigger embryonic pathways and alter mitral leaflet collagen content, ultimately leading to valve remodeling. Identifying patients with early annular planarity prior to substantial leaflet remodeling may provide early treatments to prevent increasing mitral regurgitation.
Collapse
Affiliation(s)
- Salvatore Pasta
- Department of Engineering, Università degli Studi di Palermo, Palermo, Italy
- Department of Research, IRCCS ISMETT, Palermo, Italy
| | - Eluisa La Franca
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta Specializzazione), Palermo, Italy
| | - Fabrizio Crascì
- Department of Engineering, Università degli Studi di Palermo, Palermo, Italy
- Department of Research, IRCCS ISMETT, Palermo, Italy
| | | | - Manlio Cipriani
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta Specializzazione), Palermo, Italy
| | - Francesco Fulvio Faletra
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta Specializzazione), Palermo, Italy
| |
Collapse
|
|
4
|
Challa AB, Radike M, Rizvi A, Weber NM, Wamil M, Poigai Arunachalam S, Sheedy E, Leng S, Williamson EE. Interobserver and intraobserver variability among different vendors for mitral valve assessment: implications for transcatheter mitral valve repair. LA RADIOLOGIA MEDICA 2025; 130:296-301. [PMID: 39815144 DOI: 10.1007/s11547-025-01950-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 01/01/2025] [Indexed: 01/18/2025]
Abstract
PURPOSE Pre-procedural imaging is critical for transcatheter mitral valve repair planning in patients with mitral valve disease. As differences among various measurement techniques for valve evaluation are still poorly understood, we sought to assess the intra- and interobserver agreement of complex measurements derived from a prototype mitral evaluation tool (Siemens) and a commercially available tool (CVI42) using both saddle- and D-shaped mitral annulus techniques. MATERIALS AND METHODS Multiphasic cardiac computed tomography angiography data were loaded into each software. Three expert readers independently measured the annuli on systolic- and diastolic-phase images using both tools. Measurement agreement between the tools was assessed with t tests, with p ≤ 0.05 considered statistically significant. Intraclass correlation coefficient (ICC) was used for interobserver agreement. Bland-Altman plots were used to assess for systematic differences. RESULTS Ten patients (mean age: 61.9 ± 9.9 years, 70%males) were included, with either normal mitral valve (n = 5) or with primary mitral regurgitation (n = 5). The intraobserver comparison showed statistically significantly different circumference and planar surface areas only for one reader in each group. However, there was significant difference (p ≤ 0.05) between measurements for intercommissural distance, septolateral distance, and intertrigone distance. The interobserver agreement was good (ICC, 0.60-0.74) to excellent (ICC, 0.75-1.00). There were systematic differences in mitral annulus area parameters for both saddle- and D-shaped annulus. CONCLUSION Both tools effectively assess mitral annulus with good-to-excellent interobserver agreement. As there were systematic differences in the annular area and distance, use of the same software should be considered in clinical and research workflows.
Collapse
Affiliation(s)
- Apurva B Challa
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Monika Radike
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
- Department of Radiology, Liverpool Heart and Chest Hospital, Liverpool, UK.
- Cardiovascular Program-ICCC, Research Institute Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Barcelona, Spain.
| | - Asim Rizvi
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
- Medical Branch at Galveston, The University of Texas, 301 University Blvd, Galveston, TX, USA
| | - Nikkole M Weber
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | | | | | - Emily Sheedy
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Shuai Leng
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Eric E Williamson
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| |
Collapse
|
|
5
|
Sonaglioni A, Nicolosi GL, Bruno A, Lombardo M. Accuracy of noninvasive screening exercise tests for detecting coronary artery disease in symptomatic patients with mitral valve prolapse: a systematic review. J Cardiovasc Med (Hagerstown) 2025; 26:122-130. [PMID: 39976064 DOI: 10.2459/jcm.0000000000001701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2024] [Accepted: 12/30/2024] [Indexed: 02/21/2025]
Abstract
BACKGROUND Since the 1970s, only a few studies have evaluated the accuracy of noninvasive screening exercise tests for detecting coronary artery disease (CAD) in symptomatic individuals with mitral valve prolapse (MVP). The present systematic review has been designed to summarize the main findings of these studies and to assess the overall pooled estimates of sensivity and specificity of exercise ECG, exercise myocardial perfusion scintigraphy (MPS) and exercise stress echocardiography (ESE) in diagnosing CAD among MVP individuals. METHODS All studies examining the specificity and sensitivity of exercise ECG and/or exercise MPS and/or ESE in detecting obstructive CAD in symptomatic MVP patients, selected from PubMed and EMBASE databases, were included. There was no limitation of time period. The risk of bias was assessed by using the National Institutes of Health (NIH) Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. RESULTS The full texts of 11 studies with 840 MVP individuals were analyzed. True obstructive CAD was documented in 11.1% of MVP individuals (range 0-31.2%). When used in MVP patients with suspected CAD, exercise ECG, exercise MPS and ESE showed a pooled specificity of 61.9% (range 25-91.7%), 82.3% (range 25-100%) and 89% (range 80.5-97.6%), respectively, and a pooled sensitivity of 80% (range 50-100%), 96.7% (range 90-100%) and 91% (range 82-100%), respectively. The pooled positive predictive value was 33.2% (range 23.1-44.8%) for exercise ECG, 100% for exercise MPS and 80.2% (range 75.8-84.6%) for ESE, whereas the pooled negative predictive value was 80% (range 50-100%) for exercise ECG, 97% for exercise MPS and 99% (range 97.6-100%) for ESE. CONCLUSION ESE appears to be the first-choice screening method for CAD detection in symptomatic MVP individuals. It allows true CAD in symptomatic MVP individuals with false-positive exercise ECG results to be ruled out, without ionizing radiation exposure.
Collapse
Affiliation(s)
| | | | - Antonino Bruno
- Laboratory of Innate Immunity, IRCCS MultiMedica, Milan
- Laboratory of Immunology and General Pathology, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | | |
Collapse
|
|
6
|
Shpitzen S, Rosen H, Ben-Zvi A, Meir K, Levin G, Gudgold A, Ben Dor S, Haffner R, Zwas DR, Leibowitz D, Slaugenhaupt SA, Banin E, Mizrachi R, Obolensky A, Levine RA, Gilon D, Leitersdorf E, Tessler I, Reshef N, Durst R. Characterization of LTBP2 mutation causing mitral valve prolapse. EUROPEAN HEART JOURNAL OPEN 2025; 5:oeae106. [PMID: 39882270 PMCID: PMC11775471 DOI: 10.1093/ehjopen/oeae106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2024] [Revised: 10/14/2024] [Accepted: 12/17/2024] [Indexed: 01/31/2025]
Abstract
Aims Mitral valve prolapse (MVP) is a common valvular disorder associated with significant morbidity and mortality, with a strong genetic basis. This study aimed to identify a mutation in a family with MVP and to characterize the valve phenotype in LTBP2 knockout (KO) mice. Methods and results Exome sequencing and segregation analysis were performed on a large family with MVP. Two mouse strains were generated: a complete KO of the LTBP2 gene and a knockin (KI) of the human mutation. At 6 months, phenotyping was conducted using echocardiography, histology, eye optical coherence tomography, and quantitative polymerase chain reaction analysis for TGF-β signalling targets (periostin/POSTN, RUNX2, and CTGF) in valve tissues. LTBP2 rs117800773 V1506M mutation exhibited segregation with MVP. LTBP2 KO mice had a higher incidence of myxomatous changes by histology (7 of 9 of KO vs. 0 of 7 control animals, P = 0.00186) and echocardiography (7 of 9 vs. 0 of 8, P = 0.0011). LTBP2 KI mice for the human mutation showed a significantly elevated myxomatous histological phenotype (8 of 8 vs. 0 of 9, P = 0.00004) as well as by echocardiography (6 of 8 vs. 0 of 9, P = 0.00123). Knockout mice demonstrated an increase in the depth of the anterior chamber as well as reduced visual acuity. LTBP2 KO mice demonstrated overexpression of both TGF-β signalling targets RUNX2 and periostin (P = 0.0144 and P = 0.001826, respectively). Conclusion We report a KO mouse strain with an LTBP2 mutation, demonstrating a valve phenotype, alongside a family with a novel mutation linked to MVP.
Collapse
Affiliation(s)
- Shoshi Shpitzen
- Department of Medicine, Cardiovascular Precision Medicine Center, Hadassah Hebrew University Medical Center, P.O. Box 12000, 9112001 Jerusalem, Israel
| | - Haim Rosen
- The Kuvin Center for the Study of Infectious and Tropical Diseases, Institute for Medical Research-Israel-Canada, Hebrew University—Hadassah Medical School, 9112001 Jerusalem, Israel
| | - Ayal Ben-Zvi
- Developmental Biology and Cancer Research, Hadassah—Hebrew University Medical School, 9112001 Jerusalem, Israel
| | - Karen Meir
- Department of Pathology, Hadassah Hebrew University Medical Center, P.O. Box 12000, 9112001 Jerusalem, Israel
| | - Galina Levin
- Department of Cardiology, Hadassah Hebrew University Medical Center, P.O. Box 12000, 9112001 Jerusalem, Israel
| | - Amichay Gudgold
- Department of Medicine, Cardiovascular Precision Medicine Center, Hadassah Hebrew University Medical Center, P.O. Box 12000, 9112001 Jerusalem, Israel
| | - Shifra Ben Dor
- Department of Life Sciences Core Facilities, Weizmann Institute of Science, Herzl St 234, 7610001 Rehovot, Israel
| | - Rebecca Haffner
- Department of Veterinary Resources, Weizmann Institute of Science, Herzl St 234, 7610001 Rehovot, Israel
| | - Donna R Zwas
- Department of Cardiology, Hadassah Hebrew University Medical Center, P.O. Box 12000, 9112001 Jerusalem, Israel
| | - David Leibowitz
- Department of Cardiology, Hadassah Hebrew University Medical Center, P.O. Box 12000, 9112001 Jerusalem, Israel
| | - Susan A Slaugenhaupt
- Center for Genomic Medicine, Massachusetts General Hospital Research Institute, 185 Cambridge Street, Boston, MA 02114, USA
| | - Eyal Banin
- Center for Retinal and Macular Degenerations, Department of Ophthalmology, Hadassah Hebrew University Medical Center, P.O. Box 12000, 911200120 Jerusalem, Israel
| | - Rotem Mizrachi
- Center for Retinal and Macular Degenerations, Department of Ophthalmology, Hadassah Hebrew University Medical Center, P.O. Box 12000, 911200120 Jerusalem, Israel
| | - Alexey Obolensky
- Center for Retinal and Macular Degenerations, Department of Ophthalmology, Hadassah Hebrew University Medical Center, P.O. Box 12000, 911200120 Jerusalem, Israel
| | - Robert A Levine
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, 185 Cambridge Street, Boston, MA 02114, USA
| | - Dan Gilon
- Department of Cardiology, Hadassah Hebrew University Medical Center, P.O. Box 12000, 9112001 Jerusalem, Israel
| | - Eran Leitersdorf
- Department of Medicine, Cardiovascular Precision Medicine Center, Hadassah Hebrew University Medical Center, P.O. Box 12000, 9112001 Jerusalem, Israel
| | - Idit Tessler
- Department of Medicine, Cardiovascular Precision Medicine Center, Hadassah Hebrew University Medical Center, P.O. Box 12000, 9112001 Jerusalem, Israel
- Sheba Medical Center, Ramat Gan, P.O. Box 12000, 911200120 Jerusalem, Israel
- Faculty of Medicine, Tel-Aviv University, P.O. Box 12000, 911200120 Tel-Aviv, Israel
| | - Noga Reshef
- Department of Medicine, Cardiovascular Precision Medicine Center, Hadassah Hebrew University Medical Center, P.O. Box 12000, 9112001 Jerusalem, Israel
| | - Ronen Durst
- Department of Medicine, Cardiovascular Precision Medicine Center, Hadassah Hebrew University Medical Center, P.O. Box 12000, 9112001 Jerusalem, Israel
- Department of Cardiology, Hadassah Hebrew University Medical Center, P.O. Box 12000, 9112001 Jerusalem, Israel
| |
Collapse
|
|
7
|
Sonaglioni A, Nicolosi GL, Bruno A, Lombardo M, Muti P. Echocardiographic Assessment of Mitral Valve Prolapse Prevalence before and after the Year 1999: A Systematic Review. J Clin Med 2024; 13:6160. [PMID: 39458110 PMCID: PMC11508471 DOI: 10.3390/jcm13206160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2024] [Revised: 10/06/2024] [Accepted: 10/14/2024] [Indexed: 10/28/2024] Open
Abstract
Background: Over the last five decades, a fair number of echocardiographic studies have evaluated the prevalence of mitral valve prolapse (MVP) in various cohorts of individuals, including heterogeneous study populations. The present systematic review has been primarily designed to summarize the main findings of these studies and to estimate the overall MVP prevalence in the general community. Methods: All echocardiographic studies assessing the MVP prevalence in various cohorts of individuals, selected from PubMed and EMBASE databases, were included. There was no limitation of time period. The risk of bias was assessed by using the National Institutes of Health (NIH) Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Results: The full texts of 21 studies with 1354 MVP individuals out of 63,723 participants were analyzed. The overall pooled prevalence of MVP was 4.9% (range of 0.6-21%). When dividing the studies in two groups according to the echocardiographic criteria used for MVP diagnosis (less specific old criteria or more specific new criteria, respectively), the estimated pooled prevalence of MVP was 7.8% (range of 2-21%) for the older studies (performed between 1976 and 1998) and 2.2% (range of 0.6-4.2%) for the more recent ones (conducted between 1999 and 2021). Potential selection bias, hospital- or referral-based series, and the use of less specific echocardiographic criteria for MVP diagnosis have been indicated as the main reasons for the higher MVP prevalence detected by the older studies. MVP was commonly associated with a narrow antero-posterior thoracic diameter, isolated ventricular premature beats and nonspecific ST-T-wave abnormalities on a resting electrocardiogram, mild-to-moderate mitral regurgitation (MR), the reduced probability of obstructive coronary artery disease, and a low frequency of serious complications, such as severe MR, infective endocarditis, heart failure, stroke, and atrial fibrillation. Conclusions: MVP has a low prevalence in the general population, regardless of age, gender, and ethnicity, and is associated with a good outcome.
Collapse
Affiliation(s)
| | | | - Antonino Bruno
- Laboratory of Innate Immunity, IRCCS MultiMedica, 20138 Milan, Italy;
- Laboratory of Immunology and General Pathology, Department of Biotechnology and Life Sciences, University of Insubria, 21100 Varese, Italy
| | | | - Paola Muti
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20138 Milan, Italy;
- IRCCS MultiMedica, 20099 Milan, Italy
| |
Collapse
|
|
8
|
Liu Z, Ren Y, Liang J, Zhang Y, Zhang H, Wang M, Xu L, Liu Y, Jiang W, Zhang H. Feasibility and Exploration of a Standardized Protocol for Cardiac CT Assessment of Rheumatic Mitral Disease. Rev Cardiovasc Med 2024; 25:322. [PMID: 39355606 PMCID: PMC11440403 DOI: 10.31083/j.rcm2509322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 05/10/2024] [Accepted: 05/16/2024] [Indexed: 10/03/2024] Open
Abstract
Rheumatic mitral valve disease often requires surgical interventions, such as percutaneous mitral commissurotomy, surgical mitral valve repair, or replacement, especially in severe cases. This necessitates a precise preoperative assessment of the extent of mitral valve disease. Currently, transthoracic echocardiography, the gold standard for preoperative assessment, has limitations, such as restricted acoustic windows and dependence on the operator, which can affect the evaluation of subvalvular structures and calcification of the mitral valve. Previous studies have shown that cardiac computed tomography (CT), with its high resolution, strong multiplanar reconstruction capabilities, and sensitivity to calcifications, can effectively overcome these limitations. Therefore, this study aims to summarize and evaluate the effectiveness of cardiac CT in examining mitral valve leaflets, annulus, and subvalvular structures. It also reviews the feasibility and guiding significance of using cardiac CT to assess characteristic rheumatic mitral valve lesions.
Collapse
Affiliation(s)
- Zhou Liu
- Department of Cardiac Surgery, Beijing Anzhen Hospital, 100029 Beijing, China
| | - Yue Ren
- Department of Radiology, Beijing Anzhen Hospital, 100029 Beijing, China
| | - Jiajun Liang
- Department of Cardiac Surgery, Beijing Anzhen Hospital, 100029 Beijing, China
| | - Yazhe Zhang
- Department of Cardiac Surgery, Beijing Anzhen Hospital, 100029 Beijing, China
| | - Hongkai Zhang
- Department of Radiology, Beijing Anzhen Hospital, 100029 Beijing, China
| | - Maozhou Wang
- Department of Cardiac Surgery, Beijing Anzhen Hospital, 100029 Beijing, China
| | - Lei Xu
- Department of Radiology, Beijing Anzhen Hospital, 100029 Beijing, China
| | - Yuyong Liu
- Department of Cardiac Surgery, Beijing Anzhen Hospital, 100029 Beijing, China
- Beijing Institute of Heart, Lung and Blood Vessel Diseases, 100029 Beijing, China
- Beijing Lab for Cardiovascular Precision Medicine, 100069 Beijing, China
- Department of Cardiac Surgery, The First Affiliated Hospital of Anhui Medical University, 230022 Hefei, Anhui, China
| | - Wenjian Jiang
- Department of Cardiac Surgery, Beijing Anzhen Hospital, 100029 Beijing, China
- Beijing Institute of Heart, Lung and Blood Vessel Diseases, 100029 Beijing, China
- Beijing Lab for Cardiovascular Precision Medicine, 100069 Beijing, China
| | - Hongjia Zhang
- Department of Cardiac Surgery, Beijing Anzhen Hospital, 100029 Beijing, China
- Beijing Institute of Heart, Lung and Blood Vessel Diseases, 100029 Beijing, China
- Beijing Lab for Cardiovascular Precision Medicine, 100069 Beijing, China
| |
Collapse
|
|
9
|
Cameron JN, Kadhim KI, Kamsani SH, Han HC, Farouque O, Sanders P, Lim HS. Arrhythmogenic Mitral Valve Prolapse: Can We Risk Stratify and Prevent Sudden Cardiac Death? Arrhythm Electrophysiol Rev 2024; 13:e11. [PMID: 39145277 PMCID: PMC11322952 DOI: 10.15420/aer.2023.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 01/10/2024] [Indexed: 08/16/2024] Open
Abstract
Ventricular arrhythmias associated with mitral valve prolapse (MVP) and the capacity to cause sudden cardiac death (SCD), referred to as 'malignant MVP', are an increasingly recognised, albeit rare, phenomenon. SCD can occur without significant mitral regurgitation, implying an interaction between mechanical derangements affecting the mitral valve apparatus and left ventricle. Risk stratification of these arrhythmias is an important clinical and public health issue to provide precise and targeted management. Evaluation requires patient and family history, physical examination and electrophysiological and imaging-based modalities. We provide a review of arrhythmogenic MVP, exploring its epidemiology, demographics, clinical presentation, mechanisms linking MVP to SCD, markers of disease severity, testing modalities and management, and discuss the importance of risk stratification. Even with recently improved understanding, it remains challenging how best to weight the prognostic importance of clinical, imaging and electrophysiological data to determine a clear high-risk arrhythmogenic profile in which an ICD should be used for the primary prevention of SCD.
Collapse
Affiliation(s)
- James N Cameron
- Department of Cardiology, Austin Health Melbourne, Australia
- Faculty of Medicine, Dentistry and Health Sciences University of Melbourne Melbourne, Australia
| | - Kadhim I Kadhim
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital Adelaide, Australia
| | - Suraya Hb Kamsani
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital Adelaide, Australia
| | - Hui-Chen Han
- Victorian Heart Institute, Monash University Melbourne, Australia
| | - Omar Farouque
- Department of Cardiology, Austin Health Melbourne, Australia
- Faculty of Medicine, Dentistry and Health Sciences University of Melbourne Melbourne, Australia
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital Adelaide, Australia
| | - Han S Lim
- Department of Cardiology, Austin Health Melbourne, Australia
- Faculty of Medicine, Dentistry and Health Sciences University of Melbourne Melbourne, Australia
- Department of Cardiology, Northern Health Melbourne, Australia
| |
Collapse
|
|
10
|
Khoo NS. Time to Look Up from Two Dimensions to See the Third in Mitral Valve Research. J Am Soc Echocardiogr 2024; 37:268-269. [PMID: 38309836 DOI: 10.1016/j.echo.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 12/08/2023] [Indexed: 02/05/2024]
Affiliation(s)
- Nee Scze Khoo
- Department of Pediatrics, Univeristy of Alberta, Stollery Children's Hospital, Edmonton, Alberta, Canada.
| |
Collapse
|
|
11
|
Deng Y, Liu J, Wu S, Li X, Yu H, Tang L, Xie M, Zhang C. Arrhythmic Mitral Valve Prolapse: A Comprehensive Review. Diagnostics (Basel) 2023; 13:2868. [PMID: 37761235 PMCID: PMC10528205 DOI: 10.3390/diagnostics13182868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 08/22/2023] [Accepted: 08/30/2023] [Indexed: 09/29/2023] Open
Abstract
Mitral valve prolapse (MVP) is a prevalent cardiac disorder that impacts approximately 2% to 3% of the overall population. While most patients experience a benign clinical course, there is evidence suggesting that a subgroup of MVP patients face an increased risk of sudden cardiac death (SCD). Although a conclusive causal link between MVP and SCD remains to be firmly established, various factors have been associated with arrhythmic mitral valve prolapse (AMVP). This study aims to provide a comprehensive review encompassing the historical background, epidemiology, pathology, clinical manifestations, electrocardiogram (ECG) findings, and treatment of AMVP patients. A key focus is on utilizing multimodal imaging techniques to accurately diagnose AMVP and to highlight the role of mitral annular disjunction (MAD) in AMVP.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Chun Zhang
- Department of Interventional Ultrasound, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China; (Y.D.); (J.L.); (S.W.); (X.L.); (H.Y.); (L.T.); (M.X.)
| |
Collapse
|
|
12
|
Essayagh B, Sabbag A, El-Am E, Cavalcante JL, Michelena HI, Enriquez-Sarano M. Arrhythmic mitral valve prolapse and mitral annular disjunction: pathophysiology, risk stratification, and management. Eur Heart J 2023; 44:3121-3135. [PMID: 37561995 DOI: 10.1093/eurheartj/ehad491] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 06/11/2023] [Accepted: 07/19/2023] [Indexed: 08/12/2023] Open
Abstract
Mitral valve prolapse (MVP) is the most frequent valve condition but remains a conundrum in many aspects, particularly in regard to the existence and frequency of an arrhythmic form (AMVP) and its link to sudden cardiac death. Furthermore, the presence, frequency, and significance of the anatomic functional feature called mitral annular disjunction (MAD) have remained widely disputed. Recent case series and cohorts have shattered the concept that MVP is most generally benign and have emphasized the various phenotypes associated with clinically significant ventricular arrhythmias, including AMVP. The definition, evaluation, follow-up, and management of AMVP represent the focus of the present review, strengthened by recent coherent studies defining an arrhythmic MVP phenotypic that would affect a small subset of patients with MVP at concentrated high risk. The role of MAD in this context is of particular importance, and this review highlights the characteristics of AMVP phenotypes and MAD, their clinical, multimodality imaging, and rhythmic evaluation. These seminal facts lead to proposing a risk stratification clinical pathway with consideration of medical, rhythmologic, and surgical management and have been objects of recent expert consensus statements and of proposals for new research directions.
Collapse
Affiliation(s)
- Benjamin Essayagh
- From the Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905, USA
- Department of Echocardiography, Cardio X Clinic, Cannes, France
| | - Avi Sabbag
- The Davidai Center for Rhythm Disturbances and Pacing, Chaim Sheba Medical Center, Tel Hashomer and the Sackler School of Medicine, Tel Aviv University, Ramat-Gan, Israel
| | - Edward El-Am
- From the Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905, USA
| | - João L Cavalcante
- Department of Cardiovascular Medicine, Allina Health Minneapolis Heart Institute - Abbott Northwestern Hospital, 800 E 28th St, Minneapolis, MN 55407, USA
| | - Hector I Michelena
- From the Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905, USA
| | - Maurice Enriquez-Sarano
- Department of Cardiovascular Medicine, Allina Health Minneapolis Heart Institute - Abbott Northwestern Hospital, 800 E 28th St, Minneapolis, MN 55407, USA
| |
Collapse
|
|
13
|
Pino PG, Madeo A, Lucà F, Ceravolo R, di Fusco SA, Benedetto FA, Bisignani G, Oliva F, Colivicchi F, Gulizia MM, Gelsomino S. Clinical Utility of Three-Dimensional Echocardiography in the Evaluation of Mitral Valve Disease: Tips and Tricks. J Clin Med 2023; 12:2522. [PMID: 37048605 PMCID: PMC10094963 DOI: 10.3390/jcm12072522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/22/2023] [Accepted: 03/07/2023] [Indexed: 03/29/2023] Open
Abstract
Although real-time 3D echocardiography (RT3DE) has only been introduced in the last decades, its use still needs to be improved since it is a time-consuming and operator-dependent technique and acquiring a good quality data can be difficult. Moreover, the additive value of this important diagnostic tool still needs to be wholly appreciated in clinical practice. This review aims at explaining how, why, and when performing RT3DE is useful in clinical practice.
Collapse
Affiliation(s)
- Paolo G. Pino
- Former Cardiology Department, San Camillo Forlanini Hospital, 00151 Roma, Italy
| | - Andrea Madeo
- Cardiology Department, Ferrari Hospital, 87012 Castrovillari, Italy
| | - Fabiana Lucà
- Cardiology Department, Grande Ospedale Metropolitano, GOM, AO Bianchi Melacrino Morelli, 89129 Reggio Calabria, Italy
| | - Roberto Ceravolo
- Cardiology Unit, Giovanni Paolo II Hospital, 88046 Lamezia, Italy
| | | | - Francesco Antonio Benedetto
- Cardiology Department, Grande Ospedale Metropolitano, GOM, AO Bianchi Melacrino Morelli, 89129 Reggio Calabria, Italy
| | | | - Fabrizio Oliva
- De Gasperis Cardio Center, Niguarda Hospital, 20162 Milan, Italy
| | - Furio Colivicchi
- Cardiology Department, San Filippo Neri Hospital, 00135 Rome, Italy
| | | | - Sandro Gelsomino
- Cardiothoracic Department, Maastricht University, 6211 LK Maastrich, The Netherlands
| |
Collapse
|
|
14
|
Krawczyk-Ożóg A, Hołda MK, Batko J, Bartuś S, Rajtar-Salwa R. Three-dimensional cardiac computed tomography compared with autopsied material for the assessment of the mitral valve. Clin Anat 2023; 36:250-255. [PMID: 36271778 DOI: 10.1002/ca.23967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 10/17/2022] [Indexed: 11/08/2022]
Abstract
To compare the morphometrical features of non-diseased mitral valves imaged in three-dimensional (3D) cardiac computed tomography with those analyzed macroscopically in autopsied healthy human hearts. A total of 51 cardiac computed tomography scans and 120 adult autopsied human hearts without cardiovascular disease were examined. The 3D reconstruction and visualization software (Mimics Innovation Suite 22, Materialise) was used for heart chambers semi-automatic segmentation and myocardial manual segmentation to visualize a 3D structure of the mitral valve complex and to perform all measurements. Direct comparison of corresponding mitral valve parameters revealed significant differences between obtained results. Significantly larger intercommisural diameter, aorto-mural diameter, and perimeter of the mitral annulus were observed in tomographic scans (all p < 0.0001). However, the intercommissural/aorto-mural diameter ratio showed comparable values for both groups. Nevertheless, the size of anterior mitral leaflet was higher in autopsied material. The height of the P2 scallops was the only parameter that show no significant difference between two groups (p = 0.3). The use of 3D postprocessing algorithms provides a very accurate image of the mitral valve structure, which could be useful for the precise non-invasive assessment of mitral valve size and structure. Three-dimensional contrast enhanced cardiac computed tomography significantly overestimates the measurements of the mitral annulus compared to postmortem analysis.
Collapse
Affiliation(s)
- Agata Krawczyk-Ożóg
- Department of Anatomy, HEART - Heart Embryology and Anatomy Research Team, Jagiellonian University Medical College, Krakow, Poland.,Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
| | - Mateusz K Hołda
- Department of Anatomy, HEART - Heart Embryology and Anatomy Research Team, Jagiellonian University Medical College, Krakow, Poland.,Division of Cardiovascular Sciences, The University of Manchester, UK
| | - Jakub Batko
- Department of Anatomy, HEART - Heart Embryology and Anatomy Research Team, Jagiellonian University Medical College, Krakow, Poland
| | - Stanisław Bartuś
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland.,2nd Department of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Renata Rajtar-Salwa
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
| |
Collapse
|
|
15
|
Guta AC, El-Tallawi KC, Nguyen DT, Qamar F, Nguyen T, Zoghbi WA, Lawrie G, Graviss EA, Shah DJ. Prevalence and Clinical Implications of Tricuspid Valve Prolapse Based on Magnetic Resonance Diagnostic Criteria. J Am Coll Cardiol 2023; 81:S0735-1097(22)07642-2. [PMID: 36813687 DOI: 10.1016/j.jacc.2022.11.052] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 11/14/2022] [Accepted: 11/21/2022] [Indexed: 02/22/2023]
Abstract
BACKGROUND Tricuspid valve prolapse (TVP) is an uncertain diagnosis with unknown clinical significance because of a scarcity of published data. OBJECTIVES In this study, cardiac magnetic resonance was used to: 1) propose diagnostic criteria for TVP; 2) evaluate the prevalence of TVP in patients with primary mitral regurgitation (MR); and 3) identify the clinical implications of TVP with regard to tricuspid regurgitation (TR). METHODS Forty-one healthy volunteers were analyzed to identify normal tricuspid leaflet displacement and propose criteria for TVP. A total of 465 consecutive patients with primary MR (263 with mitral valve prolapse [MVP] and 202 with nondegenerative mitral valve disease [non-MVP]) were phenotyped for the presence and clinical significance of TVP. RESULTS The proposed TVP criteria included right atrial displacement of ≥2 mm for the anterior and posterior tricuspid leaflets and ≥3 mm for the septal leaflet. Thirty-one (24%) subjects with single-leaflet MVP and 63 (47%) with bileaflet MVP met the proposed criteria for TVP. TVP was not evident in the non-MVP cohort. Patients with TVP were more likely to have severe MR (38.3% vs 18.9%; P < 0.001) and advanced TR (23.4% of patients with TVP demonstrated moderate or severe TR vs 6.2% of patients without TVP; P < 0.001), independent of right ventricular systolic function. CONCLUSIONS TR in subjects with MVP should not be routinely considered functional, as TVP is a prevalent finding associated with MVP and more often associated with advanced TR compared with patients with primary MR without TVP. A comprehensive assessment of tricuspid anatomy should be an important component of the preoperative evaluation for mitral valve surgery.
Collapse
Affiliation(s)
- Andrada C Guta
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA
| | | | - Duc T Nguyen
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA
| | - Fatima Qamar
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA
| | - Thuy Nguyen
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA
| | - William A Zoghbi
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA
| | - Gerald Lawrie
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA
| | - Edward A Graviss
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA
| | - Dipan J Shah
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA.
| |
Collapse
|
|
16
|
Mantegazza V, Gripari P, Tamborini G, Muratori M, Fusini L, Ghulam Ali S, Garlaschè A, Pepi M. 3D echocardiography in mitral valve prolapse. Front Cardiovasc Med 2023; 9:1050476. [PMID: 36704460 PMCID: PMC9871497 DOI: 10.3389/fcvm.2022.1050476] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 12/20/2022] [Indexed: 01/11/2023] Open
Abstract
Mitral valve prolapse (MVP) is the leading cause of mitral valve surgery. Echocardiography is the principal imaging modality used to diagnose MVP, assess the mitral valve morphology and mitral annulus dynamics, and quantify mitral regurgitation. Three-dimensional (3D) echocardiographic (3DE) imaging represents a consistent innovation in cardiovascular ultrasound in the last decades, and it has been implemented in routine clinical practice for the evaluation of mitral valve diseases. The focus of this review is the role and the advantages of 3DE in the comprehensive evaluation of MVP, intraoperative and intraprocedural monitoring.
Collapse
Affiliation(s)
- Valentina Mantegazza
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy,Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy,*Correspondence: Valentina Mantegazza ✉
| | - Paola Gripari
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Gloria Tamborini
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Manuela Muratori
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Laura Fusini
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy,Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Sarah Ghulam Ali
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Anna Garlaschè
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Mauro Pepi
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| |
Collapse
|
|
17
|
Silva-Verissimo W, El Louali F, Godio-Raboutet Y, Leblond L, Sourdon J, Rapacchi S, Evin M. Traction mechanical characterization of porcine mitral valve annulus. J Biomech 2023; 146:111396. [PMID: 36459849 DOI: 10.1016/j.jbiomech.2022.111396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 11/07/2022] [Accepted: 11/16/2022] [Indexed: 11/21/2022]
Abstract
The Mitral Annulus (MA) is an anisotropic, fibrous, flexible and dynamical structure. While MA dynamics are well documented, its passive mechanical properties remain poorly investigated to complete the design of adequate prostheses. Mechanical properties in traction on four sections of the MA (aortic, left, posterior and right segments) were assessed using a traction test system with a 30 N load cell and pulling jaws for sample fixation. Samples were submitted to a 1.5 N pre-load, 10 pre-conditioning cycles. Three strain rates were tested (5 %/min, 7 %/min and 13 %/min), the first two up to 10 % strain and the last until rupture. High-resolution diffusion-MRI provided microstructural mapping of fractional anisotropy and mean diffusion within muscle and collagen fibres. Ten MA from porcine hearts were excised resulting in 40 tested samples, out of which 28 were frozen prior to testing. Freezing samples significantly increased Young Moduli for all strain rates. No significant differences were found between Young Moduli at different strain rates (fresh samples 2.4 ± 1.1 MPa, 3.8 ± 2.2 MPa and 3.1 ± 1.8 MPa for increasing strain rates in fresh samples), while significant differences were found when comparing aortic with posterior and posterior with lateral (p < 0.012). Aortic segments deformed the most (24.1 ± 9.4 %) while lateral segments endured the highest stress (>0.3 MPa), corresponding to higher collagen fraction (0.46) and fractional anisotropy. Passive machinal properties differed between aortic and lateral segments of the MA. The process of freezing samples altered their mechanical properties. Underlying microstructural differences could be linked to changes in strain response.
Collapse
Affiliation(s)
| | - F El Louali
- Aix Marseille Univ, Univ Gustave Eiffel, LBA, Marseille, France; AP-HM, Marseille, France
| | | | | | - Joevin Sourdon
- Aix-Marseille University, CNRS, CRMBM, Marseille, France
| | - S Rapacchi
- Aix-Marseille University, CNRS, CRMBM, Marseille, France
| | - Morgane Evin
- Aix Marseille Univ, Univ Gustave Eiffel, LBA, Marseille, France.
| |
Collapse
|
|
18
|
Delling FN, Noseworthy PA, Adams DH, Basso C, Borger M, Bouatia-Naji N, Elmariah S, Evans F, Gerstenfeld E, Hung J, Le Tourneau T, Lewis J, Miller MA, Norris RA, Padala M, Perazzolo-Marra M, Shah DJ, Weinsaft JW, Enriquez-Sarano M, Levine RA. Research Opportunities in the Treatment of Mitral Valve Prolapse: JACC Expert Panel. J Am Coll Cardiol 2022; 80:2331-2347. [PMID: 36480975 PMCID: PMC9981237 DOI: 10.1016/j.jacc.2022.09.044] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 08/31/2022] [Accepted: 09/12/2022] [Indexed: 12/10/2022]
Abstract
In light of the adverse prognosis related to severe mitral regurgitation, heart failure, or sudden cardiac death in a subset of patients with mitral valve prolapse (MVP), identifying those at higher risk is key. For the first time in decades, researchers have the means to rapidly advance discovery in the field of MVP thanks to state-of-the-art imaging techniques, novel omics methodologies, and the potential for large-scale collaborations using web-based platforms. The National Heart, Lung, and Blood Institute recently initiated a webinar-based workshop to identify contemporary research opportunities in the treatment of MVP. This report summarizes 3 specific areas in the treatment of MVP that were the focus of the workshop: 1) improving management of degenerative mitral regurgitation and associated left ventricular systolic dysfunction; 2) preventing sudden cardiac death in MVP; and 3) understanding the mechanisms and progression of MVP through genetic studies and small and large animal models, with the potential of developing medical therapies.
Collapse
Affiliation(s)
- Francesca N Delling
- Department of Medicine (Cardiovascular Division), University of California-San Francisco, San Francisco, California, USA.
| | - Peter A Noseworthy
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - David H Adams
- Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Cristina Basso
- Cardiovascular Pathology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | | | | | - Sammy Elmariah
- Department of Medicine (Cardiovascular Division), University of California-San Francisco, San Francisco, California, USA; Department of Medicine, Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Frank Evans
- National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
| | - Edward Gerstenfeld
- Department of Medicine (Cardiovascular Division), University of California-San Francisco, San Francisco, California, USA
| | - Judy Hung
- Department of Medicine, Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Thierry Le Tourneau
- Nantes Université, CHU Nantes, CNRS, INSERM, l'Institut du Thorax, Nantes, France
| | - John Lewis
- Heart Valve Voice US, Washington, DC, USA
| | - Marc A Miller
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Russell A Norris
- Department of Regenerative Medicine and Cell Biology, Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Muralidhar Padala
- Department of Surgery (Cardiothoracic Surgery Division), Emory University School of Medicine, Atlanta, Georgia, USA
| | | | - Dipan J Shah
- Department of Cardiology, Houston Methodist, Weill Cornell Medical College, Houston, Texas, USA
| | | | | | - Robert A Levine
- Massachusetts General Hospital Cardiac Ultrasound Laboratory, Boston, Massachusetts, USA
| |
Collapse
|
|
19
|
Nogara A, Minacapelli A, Zambelli G, V LC, Fattouch K. Functional anatomy and echocardiographic assessment in secondary mitral regurgitation. J Card Surg 2022; 37:4103-4111. [PMID: 35998280 DOI: 10.1111/jocs.16863] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 08/02/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Mitral valve apparatus is complex and involves the mitral annulus, the leaflets, the chordae tendinae, the papillary muscles as well as the left atrial and ventricular myocardium. Secondary mitral regurgitation is a consequence of regional or global left ventricle remodeling due to an acute myocardial infarction (75% of cases) or idiopathic dilated cardiomyopathy (25% of cases). It is associated with an increase in mortality and poor outcome. There is a potential survival benefit deriving from the reduction in the degree of severity of mitral regurgitation. So the correction of the valve defect can change the clinical course and prognosis of the patient. The rationale for mitral valve treatment depends on the mitral regurgitation mechanism. Therefore, it is essential to identify and understand the pathophysiology of mitral valve regurgitation. AIM OF THE STUDY The aim of this review is to describe the crucial role of transthoracic and trans-esophageal echocardiography, in particular with three-dimensional echocardiography, for the assessment of the severity of secondary mitral regurgitation, anatomy, and hemodynamic changes in the left ventricle. Moreover, the concept that the mitral valve has no organic lesions has been abandoned. The echocardiography must allow a complete anatomical and functional evaluation of each component of the mitral valve complex, also useful to the surgeon in choosing the best surgical approach to repair the valve. CONCLUSIONS Echocardiography is the first-line imaging modality for a better selection of patients, according to geometrical modifications of mitral apparatus and left ventricle viability, especially in preoperative phase.
Collapse
Affiliation(s)
- Angela Nogara
- Department of Cardiovascular Surgery, GVM Care and Research, Maria Eleonora Hospital, Palermo, Italy
| | - Alberto Minacapelli
- Department of Cardiovascular Surgery, GVM Care and Research, Maria Eleonora Hospital, Palermo, Italy
| | - Giulia Zambelli
- Department of Cardiovascular Surgery, GVM Care and Research, Maria Eleonora Hospital, Palermo, Italy
| | - Lo Coco V
- Department of Cardiac Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Khalil Fattouch
- Department of Cardiovascular Surgery, GVM Care and Research, Maria Eleonora Hospital, Palermo, Italy
| |
Collapse
|
|
20
|
Echocardiographic Abnormalities in Autosomal Dominant Polycystic Kidney Disease (ADPKD) Patients. J Clin Med 2022; 11:jcm11205982. [PMID: 36294302 PMCID: PMC9604303 DOI: 10.3390/jcm11205982] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 09/21/2022] [Accepted: 10/05/2022] [Indexed: 11/16/2022] Open
Abstract
Cardiovascular abnormalities, such as left ventricular hypertrophy and valvular disorders, particularly mitral valve prolapse, have been described as highly prevalent among adult patients with autosomal dominant polycystic kidney disease (ADPKD). The present study aimed to assess echocardiographic parameters in a large sample of both normotensive and hypertensive ADPKD patients, regardless of kidney function level, and evaluate their association with clinical and laboratorial parameters. A retrospective study consisted of the analysis of clinical, laboratorial, and transthoracic echocardiograms data retrieved from the medical records of young adult ADPKD outpatients. A total of 294 patients (120 M/174 F, 41.0 ± 13.8 years old, 199 hypertensive and 95 normotensive) with a median estimated glomerular filtration rate (eGFR) of 75.5 mL/min/1.73 m2 were included. The hypertensive group (67.6%) was significantly older and exhibited significantly lower eGFR than the normotensive one. Increased left ventricular mass index (LVMI) was seen in 2.0%, mitral valve prolapse was observed in 3.4%, mitral valve regurgitation in 15.3%, tricuspid valve regurgitation in 16.0%, and aortic valve regurgitation in 4.8% of the whole sample. The present study suggested that the prevalence of mitral valve prolapse was much lower than previously reported, and increased LVMI was not seen in most adult ADPKD patients.
Collapse
|
|
21
|
Frishman S, Kight A, Pirozzi I, Maddineni S, Imbrie-Moore AM, Karachiwalla Z, Paulsen MJ, Kaiser AD, Woo YJ, Cutkosky MR. DynaRing: A Patient-Specific Mitral Annuloplasty Ring With Selective Stiffness Segments. J Med Device 2022; 16:031009. [PMID: 35646225 PMCID: PMC9125864 DOI: 10.1115/1.4054445] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 02/23/2022] [Indexed: 09/03/2023] Open
Abstract
Annuloplasty ring choice and design are critical to the long-term efficacy of mitral valve (MV) repair. DynaRing is a selectively compliant annuloplasty ring composed of varying stiffness elastomer segments, a shape-set nitinol core, and a cross diameter filament. The ring provides sufficient stiffness to stabilize a diseased annulus while allowing physiological annular dynamics. Moreover, adjusting elastomer properties provides a mechanism for effectively tuning key MV metrics to specific patients. We evaluate the ring embedded in porcine valves with an ex-vivo left heart simulator and perform a 150 million cycle fatigue test via a custom oscillatory system. We present a patient-specific design approach for determining ring parameters using a finite element model optimization and patient MRI data. Ex-vivo experiment results demonstrate that motion of DynaRing closely matches literature values for healthy annuli. Findings from the patient-specific optimization establish DynaRing's ability to adjust the anterior-posterior and intercommissural diameters and saddle height by up to 8.8%, 5.6%, 19.8%, respectively, and match a wide range of patient data.
Collapse
Affiliation(s)
- Samuel Frishman
- Department of Mechanical Engineering, Stanford University, Stanford, CA 94305
| | - Ali Kight
- Department of Bioengineering, Stanford University, Stanford, CA 94305
| | - Ileana Pirozzi
- Department of Bioengineering, Stanford University, Stanford, CA 94305
| | | | | | | | - Michael J. Paulsen
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA 94305
| | | | - Y. Joseph Woo
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA 94305
| | - Mark R. Cutkosky
- Department of Mechanical Engineering, Stanford University, Stanford, CA 94305
| |
Collapse
|
|
22
|
Dumont KA, Dahl Aguilera HM, Persson R, Prot V, Escobar Kvitting JP, Urheim S. Mitral Annular Elasticity Determines Severity of Regurgitation in Barlow's Disease. J Am Soc Echocardiogr 2022; 35:1037-1046. [PMID: 35842077 DOI: 10.1016/j.echo.2022.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 07/03/2022] [Accepted: 07/04/2022] [Indexed: 11/24/2022]
Abstract
AIMS Barlow's disease (BD) with late systolic mitral regurgitation provides diagnostic and therapeutic challenges. The mechanisms of the regurgitation are still unclear. We hypothesized that the onset and the severity of late systolic regurgitation are determined by annulus dynamics and the mechanical stresses imposed by the left ventricle. METHODS AND RESULTS Ten patients with BD and mitral annulus disjunction (MAD) were compared with ten healthy controls. Resting blood pressure (BP) was measured and transthoracic three-dimensional (3D) echocardiography was analyzed using a holographic display that allows tracking and measurements of mitral annulus surface area (ASA) throughout the cardiac cycle. A novel annulus elastance index (dASA/dP) was calculated between aortic valve opening and onset of mitral regurgitation. Severity of MAD was quantified as the disjunction index (mm*degree). Leaflet coaptation area was calculated using a finite element model. Peak systolic ASA in controls and patients were 9.3±0.6 and 21.1±3.1 cm2, respectively (p<0.001). In patients ASA increased rapidly during LV ejection and onset of mitral regurgitation coincided closely with peak upslope of annulus area change (dASA/dt). The finite element model showed a close association between rapid annulus displacement and coaptation area deficit in BD. Systolic annulus elastance index (0.058±0.036 cm2/mmHg) correlated strongly with disjunction index (r=0.91, p<0.0001). Moreover, regurgitation volume showed a positive correlation with systolic BP (r=0.80, p<0.01) CONCLUSION: The present pilot study supports the hypothesis that annulus dilatation may accentuate mitral valve regurgitation in patients with Barlow's disease. A novel annulus elastance index may predict the severity of mitral valve regurgitation in selected patients.
Collapse
Affiliation(s)
- Karl-Andreas Dumont
- Department of Cardiothoracic Surgery, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
| | - Hans Martin Dahl Aguilera
- Department of Structural Engineering, Faculty of Engineering Science, The Norwegian University of Science and Technology, Trondheim, Norway.
| | - Robert Persson
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.
| | - Victorien Prot
- Department of Structural Engineering, Faculty of Engineering Science, The Norwegian University of Science and Technology, Trondheim, Norway.
| | | | - Stig Urheim
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.
| |
Collapse
|
|
23
|
Guigui SA, Torres C, Escolar E, Mihos CG. Systolic anterior motion of the mitral valve in hypertrophic cardiomyopathy: a narrative review. J Thorac Dis 2022; 14:2309-2325. [PMID: 35813751 PMCID: PMC9264047 DOI: 10.21037/jtd-22-182] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 04/15/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND OBJECTIVE The prevalence of hypertrophic cardiomyopathy (HCM) is estimated to be 1 in 200 to 500 individuals, with systolic anterior motion (SAM) of the mitral valve (MV) and left ventricular outflow tract (LVOT) obstruction present in 60% to 70%. In this narrative review, we aim to elucidate the pathophysiology of SAM-septal contact and LVOT obstruction in HCM by presenting a detailed review on the anatomy of the MV apparatus in HCM, examining the various existing theories pertaining to the SAM phenomenon as supported by cardiac imaging, and providing a critical assessment of management strategies for SAM in HCM. METHODS A literature review was performed using PubMed, EMBASE, Ovid, and the Cochrane Library, of all scientific articles published through December 2021. A focus was placed on descriptive studies, reports correlating echocardiographic findings with pathologic diagnosis, and outcomes studies. KEY CONTENT AND FINDINGS The pathophysiology of SAM involves the complex interplay between HCM morphology, MV apparatus anatomic abnormalities, and labile hemodynamic derangements. Echocardiography and cardiac magnetic resonance (CMR) vector flow mapping have identified drag forces, as opposed to the "Venturi effect", as the main hydraulic forces responsible for SAM. The degree of mitral regurgitation with SAM is variable, and its severity is correlated with degree of LVOT obstruction and outcomes. First line therapy for the amelioration of SAM and LVOT obstruction is medical therapy with beta-blockers, non-dihydropyridine calcium-channel blockers, and disopyramide, in conjunction with lifestyle modifications. In refractory cases septal reduction therapy is performed, which may be combined with a 'resect-plicate-release' procedure, anterior mitral leaflet extension, surgical edge-to-edge MV repair, anterior mitral leaflet retention plasty, or secondary chordal cutting. CONCLUSIONS Recent scientific advances in the field of HCM have allowed for a maturation of our understanding of the SAM phenomenon. Cardiac imaging plays a critical role in its diagnosis, treatment, and surveillance, and in our ability to apply the appropriate therapeutic regimens. The increasing prevalence of HCM places an emphasis on continued basic and clinical research to further improve outcomes for this challenging population.
Collapse
Affiliation(s)
- Sarah A. Guigui
- Echocardiography Laboratory, Columbia University Division of Cardiology, Mount Sinai Heart Institute, Miami Beach, FL, USA
- Columbia University Division of Cardiology, Mount Sinai Heart Institute, Miami Beach, FL, USA
| | - Christian Torres
- Columbia University Division of Cardiology, Mount Sinai Heart Institute, Miami Beach, FL, USA
| | - Esteban Escolar
- Columbia University Division of Cardiology, Mount Sinai Heart Institute, Miami Beach, FL, USA
- Coronary Care Unit, Columbia University Division of Cardiology, Mount Sinai Heart Institute, Miami Beach, FL, USA
| | - Christos G. Mihos
- Echocardiography Laboratory, Columbia University Division of Cardiology, Mount Sinai Heart Institute, Miami Beach, FL, USA
- Columbia University Division of Cardiology, Mount Sinai Heart Institute, Miami Beach, FL, USA
| |
Collapse
|
|
24
|
Jedrzejczyk JH, Carlson Hanse L, Javadian S, Skov SN, Hasenkam JM, Thørnild MJ. Mitral Annular Forces and Their Potential Impact on Annuloplasty Ring Selection. Front Cardiovasc Med 2022; 8:799994. [PMID: 35059450 PMCID: PMC8765723 DOI: 10.3389/fcvm.2021.799994] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 12/10/2021] [Indexed: 01/01/2023] Open
Abstract
Objectives: To provide an overview that describes the characteristics of a mitral annuloplasty device when treating patients with a specific type of mitral regurgitation according to Carpentier's classification of mitral regurgitation.Methods: Starting with the key search term “mitral valve annuloplasty,” a literature search was performed utilising PubMed, Google Scholar, and Web of Science to identify relevant studies. A systematic approach was used to assess all publications.Results: Mitral annuloplasty rings are traditionally categorised by their mechanical compliance in rigid-, semi-rigid-, and flexible rings. There is a direct correlation between remodelling capabilities and rigidity. Thus, a rigid annuloplasty ring will have the highest remodelling capability, while a flexible ring will have the lowest. Rigid- and semi-rigid rings can furthermore be divided into flat and saddled-shaped rings. Saddle-shaped rings are generally preferred over flat rings since they decrease annular and leaflet stress accumulation and provide superior leaflet coaptation. Finally, mitral annuloplasty rings can either be complete or partial.Conclusions: A downsized rigid- or semi-rigid ring is advantageous when higher remodelling capabilities are required to correct dilation of the mitral annulus, as seen in type I, type IIIa, and type IIIb mitral regurgitation. In type II mitral regurgitation, a normosized flexible ring might be sufficient and allow for a more physiological repair since there is no annular dilatation, which diminishes the need for remodelling capabilities. However, mitral annuloplasty ring selection should always be based on the specific morphology in each patient.
Collapse
Affiliation(s)
- Johannes H. Jedrzejczyk
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
- *Correspondence: Johannes H. Jedrzejczyk
| | - Lisa Carlson Hanse
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Shadi Javadian
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Søren N. Skov
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - J. Michael Hasenkam
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Surgery, University of the Witwatersrand, Johannesburg, South Africa
| | - Marcell J. Thørnild
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| |
Collapse
|
|
25
|
Hahn RT, Saric M, Faletra FF, Garg R, Gillam LD, Horton K, Khalique OK, Little SH, Mackensen GB, Oh J, Quader N, Safi L, Scalia GM, Lang RM. Recommended Standards for the Performance of Transesophageal Echocardiographic Screening for Structural Heart Intervention: From the American Society of Echocardiography. J Am Soc Echocardiogr 2022; 35:1-76. [PMID: 34280494 DOI: 10.1016/j.echo.2021.07.006] [Citation(s) in RCA: 124] [Impact Index Per Article: 41.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Rebecca T Hahn
- Columbia University Irving College of Medicine, New York, New York
| | - Muhamed Saric
- New York University Langone Health, New York, New York
| | | | - Ruchira Garg
- Cedars-Sinai Medical Center, Los Angeles, California
| | | | | | - Omar K Khalique
- Columbia University Irving College of Medicine, New York, New York
| | - Stephen H Little
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas
| | | | - Jae Oh
- Mayo Clinic, Rochester, Minnesota
| | | | - Lucy Safi
- Hackensack University Medical Center, Hackensack, New Jersey
| | | | | |
Collapse
|
|
26
|
Mihara K, Kanemoto I, Sato K, Yasuhira Y, Watanabe I, Misumi K. Echocardiographic evaluation of deformity and enlargement of the canine mitral valve annulus associated with myxomatous degenerative mitral valve disease. J Vet Cardiol 2021; 37:8-17. [PMID: 34507141 DOI: 10.1016/j.jvc.2021.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 07/24/2021] [Accepted: 08/09/2021] [Indexed: 12/15/2022]
Abstract
INTRODUCTION/OBJECTIVES Quantitative evaluation of the morphology of the mitral valve annulus (MVA) in dogs with myxomatous mitral valve disease (MMVD) may improve the techniques of mitral valve plasty. This study aimed to compare the MVA morphology on echocardiography in normal dogs and dogs with MMVD and to compare the echocardiographic and intraoperative measurements of the MVA in dogs with MMVD. ANIMALS, MATERIALS AND METHODS The study population comprised 59 healthy dogs (control group) and 371 dogs with MMVD (MMVD group). The anterior-posterior diameter and transversal diameter (TD) of the MVA and the aortic annulus diameter were measured by echocardiography to calculate the mitral valve flattening ratio, mitral annulus area (MAA), mitral annulus circumference (MAC), contraction ratio of the MAA and aortic annulus area. In the MMVD group, the mitral annulus diameter (MAD) was macroscopically measured during mitral valve plasty. Areas and lengths were divided by the body surface area (BSA) and √BSA, respectively, for comparative analyses. RESULTS The systolic and diastolic anterior-posterior diameter/√BSA, transversal diameter/√BSA, MAA/BSA converted to a natural logarithm (Ln(MAA/BSA)), and MAC/√BSA was significantly higher in the MMVD group than the control group, whereas flattening ratio values and contraction ratio of the MAA was significantly lower. Neither the aortic annulus diameter /√BSA nor the Ln(aortic annulus area/BSA) significantly differed between groups. In the MMVD group, diastolic MAC/√BSA and MAA/BSA correlated significantly with the MAD/√BSA. CONCLUSIONS The MVA is larger and rounder in dogs with MMVD than controls. Two-dimensional echocardiographic measures of MAA and MAC correlate well with intraoperative measures of MAD.
Collapse
Affiliation(s)
- K Mihara
- Joint Graduate School of Veterinary Medicine, Kagoshima University, 1-21-24 Korimoto, Kagoshima, 8900065, Japan; Chayagasaka Animal Hospital, 1-1-5 Shin-nishi, Chikusa-ku, Nagoya, 4640003, Japan.
| | - I Kanemoto
- Chayagasaka Animal Hospital, 1-1-5 Shin-nishi, Chikusa-ku, Nagoya, 4640003, Japan
| | - K Sato
- Chayagasaka Animal Hospital, 1-1-5 Shin-nishi, Chikusa-ku, Nagoya, 4640003, Japan
| | - Y Yasuhira
- Chayagasaka Animal Hospital, 1-1-5 Shin-nishi, Chikusa-ku, Nagoya, 4640003, Japan
| | - I Watanabe
- Chayagasaka Animal Hospital, 1-1-5 Shin-nishi, Chikusa-ku, Nagoya, 4640003, Japan
| | - K Misumi
- Joint Graduate School of Veterinary Medicine, Kagoshima University, 1-21-24 Korimoto, Kagoshima, 8900065, Japan
| |
Collapse
|
|
27
|
Essayagh B, Sabbag A, Antoine C, Benfari G, Batista R, Yang LT, Maalouf J, Thapa P, Asirvatham S, Michelena HI, Enriquez-Sarano M. The Mitral Annular Disjunction of Mitral Valve Prolapse: Presentation and Outcome. JACC Cardiovasc Imaging 2021; 14:2073-2087. [PMID: 34147457 DOI: 10.1016/j.jcmg.2021.04.029] [Citation(s) in RCA: 101] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 04/19/2021] [Accepted: 04/20/2021] [Indexed: 12/25/2022]
Abstract
OBJECTIVES The aim of this study was to assess in patients with mitral valve prolapse (MVP) mitral annular disjunction (MAD) prevalence, phenotypic characteristics, and long-term outcomes (clinical arrhythmic events and excess mortality). BACKGROUND Clinical knowledge regarding MAD of MVP remains limited and controversial, and its potential link with untoward outcomes is unsubstantiated. METHODS A cohort of 595 (278 women, mean age 61 ± 16 years) consecutive patients with isolated MVP, with comprehensive clinical, rhythmic, Doppler echocardiographic, and consistent MAD assessment, were examined. MAD prevalence, associated MVP phenotypes, and outcomes (survival, clinical arrhythmic events) starting at diagnostic echocardiography were analyzed. To balance important baseline differences, propensity scoring matching was conducted among patients with and those without MAD. RESULTS The presence of MAD was common (n = 186 [31%]) in patients with MVP, generally in younger patients, and was not random but was independently associated with severe myxomatous disease involving bileaflet MVP and marked leaflet redundancy (both P ≤ 0.0002). The presence of MAD was also independently associated with a larger left ventricle (P = 0.005). Age-matched cohort survival after MVP diagnosis was not worse with MAD (10-year survival 93% ± 2% for patients without MAD and 97% ± 1% for those with MAD; P = 0.40), even adjusted comprehensively for MVP characteristics (P = 0.80) and accounting for time-dependent mitral surgery (P = 0.60). During follow-up, 170 patients had clinical arrhythmic events (ventricular tachycardia, n = 159; arrhythmia ablation, n = 14; cardioverter-defibrillator implantation, n = 14; sudden cardiac death, n = 3). MAD was independently associated with higher risk for arrhythmic events (adjusted HR: 2.60; 95% CI: 1.87-3.62; P < 0.0001). The link between MAD and arrhythmic events persisted with time-dependent mitral surgery (adjusted HR: 2.54; 95% CI: 1.84-3.50; P < 0.0001), was strong under medical management (adjusted HR: 3.21; 95% CI: 2.03-5.06; P < 0.0001) but was weaker after mitral surgery (adjusted HR: 2.07; 95% CI: 1.24-3.43; P = 0.005). CONCLUSIONS This large cohort with MVP comprehensively characterized shows that MAD is frequent at MVP diagnosis and is strongly linked to advanced myxomatous degeneration. The presence of MAD was independently associated with long-term excess incidence of clinical arrhythmic events. However, within the first 10 years post-diagnosis, MAD was not linked to excess mortality, and although reassurance should be provided from the survival point of view, careful monitoring for arrhythmias is in order for MAD.
Collapse
Affiliation(s)
- Benjamin Essayagh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA; Department of Cardiovascular Medicine, Simone Veil Hospital, Cannes, France
| | - Avi Sabbag
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Davidai Arrhythmia Center, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Clémence Antoine
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Giovanni Benfari
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA; Department of Cardiovascular Medicine, University of Verona, Verona, Italy
| | - Roberta Batista
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Li-Tan Yang
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Joseph Maalouf
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Prabin Thapa
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Samuel Asirvatham
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Hector I Michelena
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | |
Collapse
|
|
28
|
Arrhythmic Mitral Valve Prolapse: Introducing an Era of Multimodality Imaging-Based Diagnosis and Risk Stratification. Diagnostics (Basel) 2021; 11:diagnostics11030467. [PMID: 33800155 PMCID: PMC7999774 DOI: 10.3390/diagnostics11030467] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/04/2021] [Accepted: 03/05/2021] [Indexed: 01/13/2023] Open
Abstract
Mitral valve prolapse is a common cardiac condition, with an estimated prevalence between 1% and 3%. Most patients have a benign course, but ever since its initial description mitral valve prolapse has been associated to sudden cardiac death. Although the causal relationship between mitral valve prolapse and sudden cardiac death has never been clearly demonstrated, different factors have been implicated in arrhythmogenesis in patients with mitral valve prolapse. In this work, we offer a comprehensive overview of the etiology and the genetic background, epidemiology, pathophysiology, and we focus on the state-of-the-art imaging-based diagnosis of mitral valve prolapse. Going beyond the classical, well-described clinical factors, such as young age, female gender and auscultatory findings, we investigate multimodality imaging features, such as alterations of anatomy and function of the mitral valve and its leaflets, the structural and contractile anomalies of the myocardium, all of which have been associated to sudden cardiac death.
Collapse
|
|
29
|
Tayal B, Delling FN, Malahfji M, Shah DJ. Cardiac Imaging for Risk Assessment of Malignant Ventricular Arrhythmias in Patients With Mitral Valve Prolapse. Front Cardiovasc Med 2021; 8:574446. [PMID: 33659277 PMCID: PMC7917057 DOI: 10.3389/fcvm.2021.574446] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 01/06/2021] [Indexed: 11/28/2022] Open
Abstract
Recent studies have described the occurrence of complex ventricular arrhythmias and sudden cardiac death among patients with mitral valve prolapse (MVP). The reported incidence rate of sudden cardiac death or ventricular tachycardia is about 1–1.5% among patients with MVP. Various imaging markers have been associated with this increased risk, including mitral annular disjunction, replacement fibrosis by late gadolinium enhancement, and mechanical dispersion. In this review, we briefly discuss how multimodality cardiac imaging can be applied to identify MVP patients with high risk of sudden cardiac death and complex ventricular arrhythmias.
Collapse
Affiliation(s)
- Bhupendar Tayal
- Division of Cardiovascular Imaging, Houston Methodist DeBakey Heart and Vascular Institute, Houston, TX, United States.,Department of Cardiolgy, Aalborg University Hospital, Aalborg, Denmark
| | - Francesa N Delling
- Department of Cardiolgy, University of California, San Francisco, San Francisco, CA, United States
| | - Maan Malahfji
- Division of Cardiovascular Imaging, Houston Methodist DeBakey Heart and Vascular Institute, Houston, TX, United States
| | - Dipan J Shah
- Division of Cardiovascular Imaging, Houston Methodist DeBakey Heart and Vascular Institute, Houston, TX, United States
| |
Collapse
|
|
30
|
Mitral Valve Annulus Dimensions Assessment with Three-Dimensional Echocardiography Versus Computed Tomography: Implications for Transcatheter Interventions. J Clin Med 2021; 10:jcm10040649. [PMID: 33567645 PMCID: PMC7915882 DOI: 10.3390/jcm10040649] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 01/28/2021] [Accepted: 02/05/2021] [Indexed: 12/03/2022] Open
Abstract
The aim of this study is to evaluate the agreement between three-dimensional (3D) transesophageal echocardiography (TEE) and multidetector computed tomography (MDCT) for assessing mitral annular (MA) dimensions. A total of 105 patients (79 ± 9 years old, 52% male) who underwent clinically indicated 3D TEE and MDCT feasible for MA geometrical assessment were included. Using dedicated semi-automated postprocessing software, MA geometry, including mitral annular area (MAA), perimeter, septal-lateral (SL) diameter, and inter-trigonal (TT) diameter, was evaluated using 3D TEE and MDCT. Compared to 3D TEE, MAA, perimeter, and SL distance measured on MDCT data were larger (9.9 ± 3.0 vs. 9.3 ± 3.1 cm2 for MAA; 115 ± 18 vs. 108 ± 18 mm for perimeter; and 35 ± 5 vs. 32 ± 5 cm for SL distance, all p < 0.001). By contrast, the TT distance was comparable between MDCT and 3D TEE (26 ± 4 vs. 26 ± 4 cm, p = 0.258). The correlations of all the MA dimensions were good to excellent between the two modalities (R = 0.911 for MAA, 0.890 for perimeter, 0.739 for TT distance, and 0.857 for SL distance, respectively, all p < 0.001). This study showed good agreement between 3D TEE- and MDCT-derived MA measurements although MDCT systematically provided larger MAA, perimeter, and SL distance compared with 3D TEE.
Collapse
|
|
31
|
Myxomatous Mitral Valve Disease with Mitral Valve Prolapse and Mitral Annular Disjunction: Clinical and Functional Significance of the Coincidence. J Cardiovasc Dev Dis 2021; 8:jcdd8020009. [PMID: 33498935 PMCID: PMC7911536 DOI: 10.3390/jcdd8020009] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 01/19/2021] [Accepted: 01/22/2021] [Indexed: 11/17/2022] Open
Abstract
The morphological changes that occur in myxomatous mitral valve disease (MMVD) involve various components, ultimately leading to the impairment of mitral valve (MV) function. In this context, intrinsic mitral annular abnormalities are increasingly recognized, such as a mitral annular disjunction (MAD), a specific anatomical abnormality whereby there is a distinct separation between the mitral annulus and the left atrial wall and the basal portion of the posterolateral left ventricular myocardium. In recent years, several studies have suggested that MAD contributes to myxomatous degeneration of the mitral leaflets, and there is growing evidence that MAD is associated with ventricular arrhythmias and sudden cardiac death. In this review, the morphological characteristics of MAD and imaging tools for diagnosis will be described, and the clinical and functional aspects of the coincidence of MAD and myxomatous MVP will be discussed.
Collapse
|
|
32
|
Hiemstra YL, Tomsic A, Gripari P, van Wijngaarden AL, van der Pas SL, Palmen M, Klautz RJM, Pepi M, Bax JJ, Delgado V, Marsan NA. Evolution from mitral annular dysfunction to severe mitral regurgitation in Barlow's disease. Interact Cardiovasc Thorac Surg 2020; 32:506-514. [PMID: 33367628 DOI: 10.1093/icvts/ivaa304] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 10/25/2020] [Accepted: 11/03/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Barlow's disease (BD) is characterized by thick, redundant mitral valve (MV) leaflets, which can lead to prolapse and significant mitral regurgitation (MR). MV annular abnormalities are also commonly observed and increasingly recognized as possible primary pathology, with leaflet thickening being secondary to increased stress on the MV apparatus. To provide more insights into this hypothesis, the evolution of MV abnormalities over time in patients with BD was assessed. METHODS A total of 64 patients (54 ± 12 years, 72% male) with BD who underwent MV surgery and had multiple transthoracic echocardiograms (TTE) before surgery were included. In total, 186 TTE were analysed (median time interval 4.2, interquartile range 2.2-6.5 years) including specific MV characteristics. RESULTS At baseline, MV leaflet length, thickness, billowing height and annular diameter were larger in patients with BD compared to 59 healthy subjects. Systolic outward motion (curling) of the annulus was observed in 77% and severe mitral annular disjunction (≥5 mm) in 38% of patients with BD. Forty (63%) patients had MR grade I-II and 24 (37%) MR grade III-IV; at baseline, the 2 groups only differed in left atrial volume and in thickness and billowing height of the posterior leaflet, showing comparable MV annular abnormalities and dilatation despite different grades of MR. Over time, MV annulus diameter, leaflet length and billowing height increased significantly along with MR grade. CONCLUSIONS In patients with BD, MV annulus abnormalities are present at an early stage and precede the development of significant MR, suggesting their substantial role in the pathophysiology of this disease and as an important target for surgical treatment.
Collapse
Affiliation(s)
- Yasmine L Hiemstra
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Anton Tomsic
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands
| | | | | | - Stéphanie L van der Pas
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, Netherlands.,Mathematical Institute, Leiden University, Leiden, Netherlands
| | - Meindert Palmen
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Robert J M Klautz
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Mauro Pepi
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| |
Collapse
|
|
33
|
Hei S, Iwataki M, Jang JY, Kuwaki H, Fukuda S, Kim YJ, Toki M, Onoue T, Hayashi A, Nishino S, Watanabe N, Hayashida A, Tsuda Y, Araki M, Nishimura Y, Song JK, Yoshida K, Levine RA, Otsuji Y. Relations of Augmented Systolic Annular Expansion and Leaflet/Papillary Muscle Dynamics in Late-Systolic Mitral Valve Prolapse Evaluated by Echocardiography with a Speckle Tracking Analysis. Int Heart J 2020; 61:970-978. [PMID: 32999196 DOI: 10.1536/ihj.20-236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The mechanism of systolic annular expansion in mitral valve prolapse (MVP) is not clarified. Since annular expansion is systolic outward shift of MV leaflet/chorda tissue complex at superior and outer ends, annular expansion could be related to inward (superior) shift of the complex at another inferior and inner end of the papillary muscle (PM) tip and/or systolic lengthening of the tissue complex, especially MV leaflets.MV annulus systolic expansion, PMs' systolic superior shift, and MV leaflets' systolic lengthening were evaluated by echocardiography with a speckle tracking analysis in 25 normal subjects, 25 subjects with holo-systolic MVP and 20 subjects with late-systolic MVP.PMs' superior shift, MV leaflets' lengthening, MV annular area at the onset of systole and subsequent MV annulus expansion were significantly greater in late-systolic MVP than in holo-systolic MVP (4.6 ± 1.6 versus 1.5 ± 0.7 mm/m2, 2.5 ± 1.4 versus 0.6 ± 2.0 mm/m2, 6.8 ± 2.5 versus 5.7 ± 1.0 cm2/m2 and 1.6 ± 0.8 versus 0.1 ± 0.5 cm2/m2, P < 0.001, respectively). Multivariate analysis identified MV leaflets' lengthening and PMs' superior shift as independent factors associated with MV annular expansion.Conclusions: These results suggest that systolic MV annular expansion in MVP is related to abnormal MV leaflets' lengthening and PMs' superior shift.
Collapse
Affiliation(s)
- Soshi Hei
- Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine
| | - Mai Iwataki
- Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine
| | - Jeong-Yoon Jang
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine
| | - Hiroshi Kuwaki
- Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine
| | - Shota Fukuda
- Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine
| | - Yun-Jeong Kim
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine
| | - Misako Toki
- Department of Clinical Laboratory, The Sakakibara Heart Institute of Okayama
| | - Takeshi Onoue
- Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine
| | - Atsushi Hayashi
- Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine
| | - Shun Nishino
- Department of Cardiology, Miyazaki Medical Association Hospital Cardiovascular Center
| | - Nozomi Watanabe
- Department of Cardiology, Miyazaki Medical Association Hospital Cardiovascular Center
| | | | - Yuki Tsuda
- Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine
| | - Masaru Araki
- Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine
| | - Yosuke Nishimura
- Department of Cardiovascular Surgery, University of Occupational and Environmental Health, School of Medicine
| | - Jae-Kwan Song
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine
| | - Kiyoshi Yoshida
- Department of Cardiology, The Sakakibara Heart Institute of Okayama
| | - Robert A Levine
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School
| | - Yutaka Otsuji
- Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine
| |
Collapse
|
|
34
|
Ortuño JE, Vegas-Sánchez-Ferrero G, Gómez-Valverde JJ, Chen MY, Santos A, McVeigh ER, Ledesma-Carbayo MJ. Automatic estimation of aortic and mitral valve displacements in dynamic CTA with 4D graph-cuts. Med Image Anal 2020; 65:101748. [PMID: 32711368 PMCID: PMC7722502 DOI: 10.1016/j.media.2020.101748] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 05/25/2020] [Accepted: 06/02/2020] [Indexed: 11/27/2022]
Abstract
The location of the mitral and aortic valves in dynamic cardiac imaging is useful for extracting functional derived parameters such as ejection fraction, valve excursions, and global longitudinal strain, and when performing anatomical structures tracking using slice following or valve intervention's planning. Completely automatic segmentation methods are still challenging tasks because of their fast movements and the different positions that prevent good visibility of the leaflets along the full cardiac cycle. In this article, we propose a processing pipeline to track the displacement of the aortic and mitral valve annuli from high-resolution cardiac four-dimensional computed tomographic angiography (4D-CTA). The proposed method is based on the dynamic separation of left ventricle, left atrium and aorta using statistical shape modeling and an energy minimization algorithm based on graph-cuts and has been evaluated on a set of 15 electrocardiography-gated 4D-CTAs. We report a mean agreement distance between manual annotations and our proposed method of 2.52±1.06 mm for the mitral annulus and 2.00±0.69 mm for the aortic valve annulus based on valve locations detected from manual anatomical landmarks. In addition, we show the effect of detecting the valvular planes on derived functional parameters (ejection fraction, global longitudinal strain, and excursions of the mitral and aortic valves).
Collapse
Affiliation(s)
- Juan E Ortuño
- Biomedical Research Networking Centre on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain; Biomedical Image Technologies Lab, ETSI Telecomunicación, Universidad Politécnica de Madrid, Madrid, Spain.
| | - Gonzalo Vegas-Sánchez-Ferrero
- Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States; Biomedical Image Technologies Lab, ETSI Telecomunicación, Universidad Politécnica de Madrid, Madrid, Spain; Biomedical Research Networking Centre on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain
| | - Juan J Gómez-Valverde
- Biomedical Image Technologies Lab, ETSI Telecomunicación, Universidad Politécnica de Madrid, Madrid, Spain; Biomedical Research Networking Centre on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain
| | - Marcus Y Chen
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, United States
| | - Andrés Santos
- Biomedical Image Technologies Lab, ETSI Telecomunicación, Universidad Politécnica de Madrid, Madrid, Spain; Biomedical Research Networking Centre on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain
| | - Elliot R McVeigh
- Departments of Bioengineering, Medicine, and Radiology, University of California San Diego, La Jolla, California, United States
| | - María J Ledesma-Carbayo
- Biomedical Image Technologies Lab, ETSI Telecomunicación, Universidad Politécnica de Madrid, Madrid, Spain; Biomedical Research Networking Centre on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain
| |
Collapse
|
|
35
|
Bartko PE, Hülsmann M, Hung J, Pavo N, Levine RA, Pibarot P, Vahanian A, Stone GW, Goliasch G. Secondary valve regurgitation in patients with heart failure with preserved ejection fraction, heart failure with mid-range ejection fraction, and heart failure with reduced ejection fraction. Eur Heart J 2020; 41:2799-2810. [PMID: 32350503 PMCID: PMC8453270 DOI: 10.1093/eurheartj/ehaa129] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 01/12/2020] [Accepted: 02/12/2020] [Indexed: 12/27/2022] Open
Abstract
Secondary mitral regurgitation and secondary tricuspid regurgitation due to heart failure (HF) remain challenging in almost every aspect: increasing prevalence, poor prognosis, notoriously elusive in diagnosis, and complexity of therapeutic management. Recently, defined HF subgroups according to three ejection fraction (EF) ranges (reduced, mid-range, and preserved) have stimulated a structured understanding of the HF syndrome but the role of secondary valve regurgitation (SVR) across the spectrum of EF remains undefined. This review expands this structured understanding by consolidating the underlying phenotype of myocardial impairment with each type of SVR. Specifically, the current understanding, epidemiological considerations, impact, public health burden, mechanisms, and treatment options of SVR are discussed separately for each lesion across the HF spectrum. Furthermore, this review identifies important gaps in knowledge, future directions for research, and provides potential solutions for diagnosis and treatment. Mastering the challenge of SVR requires a multidisciplinary collaborative effort, both, in clinical practice and scientific approach to optimize patient outcomes.
Collapse
Affiliation(s)
- Philipp E Bartko
- Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - Martin Hülsmann
- Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - Judy Hung
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114-2696, USA
| | - Noemi Pavo
- Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - Robert A Levine
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114-2696, USA
| | - Philippe Pibarot
- Laval Hospital, Research Center Québec Heart Institute, Pavillon Ferdinand-Vandry 1050, avenue de la Médecine Local 4211, Laval University, Quebec City, Québec, Canada
| | - Alec Vahanian
- University of Paris, 5 Rue Thomas Mann, 75013 Paris, France
| | - Gregg W Stone
- Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, Cardiovascular Research Foundation, 1700 Broadway, New York, NY 10019, USA
| | - Georg Goliasch
- Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| |
Collapse
|
|
36
|
Abstract
PURPOSE OF REVIEW Degenerative mitral regurgitation (DMR) continues to be an important cause of morbidity and mortality with surgical mitral valve repair remaining the gold standard for the treatment of severe disease. The purpose of this review is to summarize recent advances in the understanding of DMR as well as the progress made in its assessment with a focus on imaging techniques. RECENT FINDINGS Recent insights into the anatomy and physiology of DMR challenge the assumption that fibroelastic deficiency and Barlow disease are part of a single DMR spectrum. Advances in echocardiography and cardiovascular MRI have the potential to improve quantification of mitral regurgitation, provide unique information on prognosis and impact of DMR, further the association between DMR and arrhythmic risk and aide in decision-making for DMR treatment. SUMMARY With growing interest in the use of noninvasive transcatheter therapies in the mitral valve space, comprehensive assessment of the mitral valve is critical to instruct decision-making and guide therapeutic strategy.
Collapse
|
|
37
|
Toomer KA, Yu M, Fulmer D, Guo L, Moore KS, Moore R, Drayton KD, Glover J, Peterson N, Ramos-Ortiz S, Drohan A, Catching BJ, Stairley R, Wessels A, Lipschutz JH, Delling FN, Jeunemaitre X, Dina C, Collins RL, Brand H, Talkowski ME, Del Monte F, Mukherjee R, Awgulewitsch A, Body S, Hardiman G, Hazard ES, da Silveira WA, Wang B, Leyne M, Durst R, Markwald RR, Le Scouarnec S, Hagege A, Le Tourneau T, Kohl P, Rog-Zielinska EA, Ellinor PT, Levine RA, Milan DJ, Schott JJ, Bouatia-Naji N, Slaugenhaupt SA, Norris RA. Primary cilia defects causing mitral valve prolapse. Sci Transl Med 2020; 11:11/493/eaax0290. [PMID: 31118289 PMCID: PMC7331025 DOI: 10.1126/scitranslmed.aax0290] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 04/25/2019] [Indexed: 12/15/2022]
Abstract
Mitral valve prolapse (MVP) affects 1 in 40 people and is the most common indication for mitral valve surgery. MVP can cause arrhythmias, heart failure, and sudden cardiac death, and to date, the causes of this disease are poorly understood. We now demonstrate that defects in primary cilia genes and their regulated pathways can cause MVP in familial and sporadic nonsyndromic MVP cases. Our expression studies and genetic ablation experiments confirmed a role for primary cilia in regulating ECM deposition during cardiac development. Loss of primary cilia during development resulted in progressive myxomatous degeneration and profound mitral valve pathology in the adult setting. Analysis of a large family with inherited, autosomal dominant nonsyndromic MVP identified a deleterious missense mutation in a cilia gene, DZIP1 A mouse model harboring this variant confirmed the pathogenicity of this mutation and revealed impaired ciliogenesis during development, which progressed to adult myxomatous valve disease and functional MVP. Relevance of primary cilia in common forms of MVP was tested using pathway enrichment in a large population of patients with MVP and controls from previously generated genome-wide association studies (GWAS), which confirmed the involvement of primary cilia genes in MVP. Together, our studies establish a developmental basis for MVP through altered cilia-dependent regulation of ECM and suggest that defects in primary cilia genes can be causative to disease phenotype in some patients with MVP.
Collapse
Affiliation(s)
- Katelynn A Toomer
- Cardiovascular Developmental Biology Center, Department of Regenerative Medicine and Cell Biology, College of Medicine, Children's Research Institute, Medical University of South Carolina, 171 Ashley Avenue, Charleston, SC 29425, USA
| | - Mengyao Yu
- INSERM, UMR-970, Paris Cardiovascular Research Center, 75015 Paris, France.,Paris Descartes University, Sorbonne Paris Cité, Faculty of Medicine, 75006 Paris, France
| | - Diana Fulmer
- Cardiovascular Developmental Biology Center, Department of Regenerative Medicine and Cell Biology, College of Medicine, Children's Research Institute, Medical University of South Carolina, 171 Ashley Avenue, Charleston, SC 29425, USA
| | - Lilong Guo
- Cardiovascular Developmental Biology Center, Department of Regenerative Medicine and Cell Biology, College of Medicine, Children's Research Institute, Medical University of South Carolina, 171 Ashley Avenue, Charleston, SC 29425, USA
| | - Kelsey S Moore
- Cardiovascular Developmental Biology Center, Department of Regenerative Medicine and Cell Biology, College of Medicine, Children's Research Institute, Medical University of South Carolina, 171 Ashley Avenue, Charleston, SC 29425, USA
| | - Reece Moore
- Cardiovascular Developmental Biology Center, Department of Regenerative Medicine and Cell Biology, College of Medicine, Children's Research Institute, Medical University of South Carolina, 171 Ashley Avenue, Charleston, SC 29425, USA
| | - Ka'la D Drayton
- Cardiovascular Developmental Biology Center, Department of Regenerative Medicine and Cell Biology, College of Medicine, Children's Research Institute, Medical University of South Carolina, 171 Ashley Avenue, Charleston, SC 29425, USA
| | - Janiece Glover
- Cardiovascular Developmental Biology Center, Department of Regenerative Medicine and Cell Biology, College of Medicine, Children's Research Institute, Medical University of South Carolina, 171 Ashley Avenue, Charleston, SC 29425, USA
| | - Neal Peterson
- Cardiovascular Developmental Biology Center, Department of Regenerative Medicine and Cell Biology, College of Medicine, Children's Research Institute, Medical University of South Carolina, 171 Ashley Avenue, Charleston, SC 29425, USA
| | - Sandra Ramos-Ortiz
- Cardiovascular Developmental Biology Center, Department of Regenerative Medicine and Cell Biology, College of Medicine, Children's Research Institute, Medical University of South Carolina, 171 Ashley Avenue, Charleston, SC 29425, USA
| | - Alex Drohan
- Cardiovascular Developmental Biology Center, Department of Regenerative Medicine and Cell Biology, College of Medicine, Children's Research Institute, Medical University of South Carolina, 171 Ashley Avenue, Charleston, SC 29425, USA
| | - Breiona J Catching
- Cardiovascular Developmental Biology Center, Department of Regenerative Medicine and Cell Biology, College of Medicine, Children's Research Institute, Medical University of South Carolina, 171 Ashley Avenue, Charleston, SC 29425, USA
| | - Rebecca Stairley
- Cardiovascular Developmental Biology Center, Department of Regenerative Medicine and Cell Biology, College of Medicine, Children's Research Institute, Medical University of South Carolina, 171 Ashley Avenue, Charleston, SC 29425, USA
| | - Andy Wessels
- Cardiovascular Developmental Biology Center, Department of Regenerative Medicine and Cell Biology, College of Medicine, Children's Research Institute, Medical University of South Carolina, 171 Ashley Avenue, Charleston, SC 29425, USA
| | - Joshua H Lipschutz
- Department of Medicine, Medical University of South Carolina, Charleston, SC 29425, USA.,Department of Medicine, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC 29401, USA
| | - Francesca N Delling
- Department of Medicine, Division of Cardiology, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Xavier Jeunemaitre
- INSERM, UMR-970, Paris Cardiovascular Research Center, 75015 Paris, France.,Paris Descartes University, Sorbonne Paris Cité, Faculty of Medicine, 75006 Paris, France.,Assistance Publique-Hôpitaux de Paris, Département de Génétique, Hôpital Européen Georges Pompidou, 75015 Paris, France
| | - Christian Dina
- INSERM, CNRS, Univ Nantes, L'Institut du Thorax, Nantes 44093, France.,CHU Nantes, L'Institut du Thorax, Service de Cardiologie, Nantes 44093, France
| | - Ryan L Collins
- Center for Genomic Medicine, Department of Neurology, Massachusetts General Hospital Research Institute, Harvard Medical School, 185 Cambridge St., Boston, MA 02114, USA
| | - Harrison Brand
- Center for Genomic Medicine, Department of Neurology, Massachusetts General Hospital Research Institute, Harvard Medical School, 185 Cambridge St., Boston, MA 02114, USA
| | - Michael E Talkowski
- Center for Genomic Medicine, Department of Neurology, Massachusetts General Hospital Research Institute, Harvard Medical School, 185 Cambridge St., Boston, MA 02114, USA
| | - Federica Del Monte
- Gazes Cardiac Research Institute, Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Rupak Mukherjee
- Gazes Cardiac Research Institute, Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Alexander Awgulewitsch
- Cardiovascular Developmental Biology Center, Department of Regenerative Medicine and Cell Biology, College of Medicine, Children's Research Institute, Medical University of South Carolina, 171 Ashley Avenue, Charleston, SC 29425, USA
| | - Simon Body
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Gary Hardiman
- Center for Genomic Medicine, Medical University of South Carolina, 135 Cannon Street, Suite 303 MSC 835, Charleston, SC 29425, USA.,Faculty of Medicine, Health and Life Sciences School of Biological Sciences, Institute for Global Food Security (IGFS), Queen's University Belfast, Belfast, Northern Ireland, BT7 1NN, UK
| | - E Starr Hazard
- Center for Genomic Medicine, Medical University of South Carolina, 135 Cannon Street, Suite 303 MSC 835, Charleston, SC 29425, USA
| | - Willian A da Silveira
- Center for Genomic Medicine, Medical University of South Carolina, 135 Cannon Street, Suite 303 MSC 835, Charleston, SC 29425, USA
| | - Baolin Wang
- Department of Genetic Medicine, Weill Medical College of Cornell University, New York, NY 10065, USA
| | - Maire Leyne
- Center for Genomic Medicine, Department of Neurology, Massachusetts General Hospital Research Institute, Harvard Medical School, 185 Cambridge St., Boston, MA 02114, USA
| | - Ronen Durst
- Cardiology Division, Hadassah Hebrew University Medical Center, POB 12000, Jerusalem, Israel
| | - Roger R Markwald
- Cardiovascular Developmental Biology Center, Department of Regenerative Medicine and Cell Biology, College of Medicine, Children's Research Institute, Medical University of South Carolina, 171 Ashley Avenue, Charleston, SC 29425, USA
| | | | - Albert Hagege
- INSERM, UMR-970, Paris Cardiovascular Research Center, 75015 Paris, France.,Paris Descartes University, Sorbonne Paris Cité, Faculty of Medicine, 75006 Paris, France.,Assistance Publique-Hôpitaux de Paris, Department of Cardiology, Hôpital Européen Georges Pompidou, 75015 Paris, France
| | - Thierry Le Tourneau
- INSERM, CNRS, Univ Nantes, L'Institut du Thorax, Nantes 44093, France.,CHU Nantes, L'Institut du Thorax, Service de Cardiologie, Nantes 44093, France
| | - Peter Kohl
- University Heart Center Freiburg, Bad Krozingen and Faculty of Medicine of the Albert-Ludwigs University Freiburg, Institute for Experimental Cardiovascular Medicine, Elsässerstr 2Q, 79110 Freiburg, Germany
| | - Eva A Rog-Zielinska
- University Heart Center Freiburg, Bad Krozingen and Faculty of Medicine of the Albert-Ludwigs University Freiburg, Institute for Experimental Cardiovascular Medicine, Elsässerstr 2Q, 79110 Freiburg, Germany
| | - Patrick T Ellinor
- Cardiovascular Research Center, Cardiology Division, Massachusetts General Hospital Research Institute, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
| | - Robert A Levine
- Cardiac Ultrasound Laboratory, Cardiology Division, Massachusetts General Hospital Research Institute, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
| | - David J Milan
- Cardiovascular Research Center, Cardiology Division, Massachusetts General Hospital Research Institute, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA.,Leducq Foundation, 265 Franklin Street, Suite 1902, Boston, MA, 02110, USA
| | - Jean-Jacques Schott
- INSERM, CNRS, Univ Nantes, L'Institut du Thorax, Nantes 44093, France.,CHU Nantes, L'Institut du Thorax, Service de Cardiologie, Nantes 44093, France
| | - Nabila Bouatia-Naji
- INSERM, UMR-970, Paris Cardiovascular Research Center, 75015 Paris, France.,Paris Descartes University, Sorbonne Paris Cité, Faculty of Medicine, 75006 Paris, France
| | - Susan A Slaugenhaupt
- Center for Genomic Medicine, Department of Neurology, Massachusetts General Hospital Research Institute, Harvard Medical School, 185 Cambridge St., Boston, MA 02114, USA
| | - Russell A Norris
- Cardiovascular Developmental Biology Center, Department of Regenerative Medicine and Cell Biology, College of Medicine, Children's Research Institute, Medical University of South Carolina, 171 Ashley Avenue, Charleston, SC 29425, USA.
| |
Collapse
|
|
38
|
Topilsky Y. Mitral Regurgitation: Anatomy, Physiology, and Pathophysiology-Lessons Learned From Surgery and Cardiac Imaging. Front Cardiovasc Med 2020; 7:84. [PMID: 32548127 PMCID: PMC7272584 DOI: 10.3389/fcvm.2020.00084] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 04/20/2020] [Indexed: 02/04/2023] Open
Abstract
The normal mitral valve is a dynamic structure that permits blood to flow from the left atrial (LA) to left ventricle (LV) during diastole and sealing of the LA from the LV during systole. The main components of the mitral apparatus are the mitral annulus (MA), the mitral leaflets, the chordae tendineae, and the papillary muscles (PM) (Figure 1). Normal valve function is dependent on the integrity and normal interplay of these components. Abnormal function of any one of the components, or their interplay can result in mitral regurgitation (MR). Understanding the anatomy and physiology of all the component of the mitral valve is important for the diagnosis, and for optimal planning of repair procedures. In this review we will focus first on normal anatomy and physiology of the different parts of the mitral valve (MA, leaflets, chordae tendineae, and PM). In the second part we will focus on the pathologic anatomic and physiologic derangements associated with different types of MR.
Collapse
Affiliation(s)
- Yan Topilsky
- The Department of Cardiology, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| |
Collapse
|
|
39
|
El-Sisi A, Dabour S, Fattouh AM, Assar E, Naguib R, AbdelMassih AF. Biventricular reverse remodeling and relationship with mitral valve prolapse after transcatheter closure of ASD secundum, a 3D echocardiographic study. J Cardiovasc Thorac Res 2020; 12:15-19. [PMID: 32211133 PMCID: PMC7080331 DOI: 10.34172/jcvtr.2020.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 12/04/2019] [Indexed: 12/02/2022] Open
Abstract
Introduction: Mitral valve prolapse (MVP) is the most common anomaly of the mitral valve. Several studies have shown prevalence of MVP in atrial septal defect (ASD) especially secundum types (II). The aims of this study is to show the potential role of 3D echocardiography in improving the diagnosis of MVP and to depict the relationship between reverse remodeling of the right and left ventricles (RV, LV) and MVP after transcatheter closure of ASD II. Methods: Sixty patients underwent transcatheter closure of ASD II and completed follow up by 2D and 3D echocardiography in Cairo University Children Hospital before the procedure and at 24 hours, 1 and 6 months after the procedure. Results: 3D echocardiography was more accurate than 2D echocardiography in detecting MVP frequency in ASD II patients (75% vs. 50%). Maximum statistically significant remodeling was detected by 3D echocardiography 1 month after the procedure (RV: LV ratio by 3D echocardiography 1.9±0.03 24 hours after the procedure vs. 1.6±0.03 1 months after the procedure, P <0.01) while 2D echocardiography was delayed in detecting biventricular reverse remodeling. 3D derived RV: LV ratio was accurate in detecting MVP status with a sensitivity of 88%. Conclusion: MVP in ASD II may be related to Biventricular remodeling; 3D echocardiography is accurate in the detection of reverse remodeling as well as MVP in ASD II patients before and after device closure.
Collapse
Affiliation(s)
- Amal El-Sisi
- Pediatric Cardiology Unit, Pediatrics' Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Shaheen Dabour
- Pediatric Cardiology Unit, Pediatrics' Department, Faculty of Medicine, Benha University, Benha, Egypt
| | - Aya M Fattouh
- Pediatric Cardiology Unit, Pediatrics' Department, Faculty of Medicine, Benha University, Benha, Egypt
| | - Effat Assar
- Pediatric Cardiology Unit, Pediatrics' Department, Faculty of Medicine, Benha University, Benha, Egypt
| | - Rasha Naguib
- Pediatric Cardiology Unit, Pediatrics' Department, Faculty of Medicine, Benha University, Benha, Egypt
| | - Antoine Fakhry AbdelMassih
- Pediatric Cardiology Unit, Pediatrics' Department, Faculty of Medicine, Cairo University, Cairo, Egypt.,Pediatric Cardio-Oncology Department, Children's Cancer Hospital Egypt (CCHE 57357), Cairo, Egypt
| |
Collapse
|
|
40
|
Fulmer D, Toomer KA, Glover J, Guo L, Moore K, Moore R, Stairley R, Gensemer C, Abrol S, Rumph MK, Emetu F, Lipschutz JH, McDowell C, Bian J, Wang C, Beck T, Wessels A, Renault MA, Norris RA. Desert hedgehog-primary cilia cross talk shapes mitral valve tissue by organizing smooth muscle actin. Dev Biol 2020; 463:26-38. [PMID: 32151560 DOI: 10.1016/j.ydbio.2020.03.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 02/27/2020] [Accepted: 03/02/2020] [Indexed: 01/01/2023]
Abstract
Non-syndromic mitral valve prolapse (MVP) is the most common heart valve disease affecting 2.4% of the population. Recent studies have identified genetic defects in primary cilia as causative to MVP, although the mechanism of their action is currently unknown. Using a series of gene inactivation approaches, we define a paracrine mechanism by which endocardially-expressed Desert Hedgehog (DHH) activates primary cilia signaling on neighboring valve interstitial cells. High-resolution imaging and functional assays show that DHH de-represses smoothened at the primary cilia, resulting in kinase activation of RAC1 through the RAC1-GEF, TIAM1. Activation of this non-canonical hedgehog pathway stimulates α-smooth actin organization and ECM remodeling. Genetic or pharmacological perturbation of this pathway results in enlarged valves that progress to a myxomatous phenotype, similar to valves seen in MVP patients. These data identify a potential molecular origin for MVP as well as establish a paracrine DHH-primary cilium cross-talk mechanism that is likely applicable across developmental tissue types.
Collapse
Affiliation(s)
- Diana Fulmer
- Department of Regenerative Medicine and Cell Biology, Medical University of South Carolina, Charleston, SC, USA
| | - Katelynn A Toomer
- Department of Regenerative Medicine and Cell Biology, Medical University of South Carolina, Charleston, SC, USA; Department of Genetic Medicine, John Hopkins, Baltimore, MD, USA
| | - Janiece Glover
- Department of Regenerative Medicine and Cell Biology, Medical University of South Carolina, Charleston, SC, USA
| | - Lilong Guo
- Department of Regenerative Medicine and Cell Biology, Medical University of South Carolina, Charleston, SC, USA
| | - Kelsey Moore
- Department of Regenerative Medicine and Cell Biology, Medical University of South Carolina, Charleston, SC, USA
| | - Reece Moore
- Department of Regenerative Medicine and Cell Biology, Medical University of South Carolina, Charleston, SC, USA
| | - Rebecca Stairley
- Department of Regenerative Medicine and Cell Biology, Medical University of South Carolina, Charleston, SC, USA
| | - Cortney Gensemer
- Department of Regenerative Medicine and Cell Biology, Medical University of South Carolina, Charleston, SC, USA
| | - Sameer Abrol
- Department of Regenerative Medicine and Cell Biology, Medical University of South Carolina, Charleston, SC, USA
| | - Mary Kate Rumph
- Department of Regenerative Medicine and Cell Biology, Medical University of South Carolina, Charleston, SC, USA
| | - Faith Emetu
- Department of Regenerative Medicine and Cell Biology, Medical University of South Carolina, Charleston, SC, USA
| | - Joshua H Lipschutz
- Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Colin McDowell
- Department of Regenerative Medicine and Cell Biology, Medical University of South Carolina, Charleston, SC, USA
| | - Justin Bian
- Department of Regenerative Medicine and Cell Biology, Medical University of South Carolina, Charleston, SC, USA
| | - Christina Wang
- Department of Regenerative Medicine and Cell Biology, Medical University of South Carolina, Charleston, SC, USA
| | - Tyler Beck
- Department of Regenerative Medicine and Cell Biology, Medical University of South Carolina, Charleston, SC, USA
| | - Andy Wessels
- Department of Regenerative Medicine and Cell Biology, Medical University of South Carolina, Charleston, SC, USA
| | | | - Russell A Norris
- Department of Regenerative Medicine and Cell Biology, Medical University of South Carolina, Charleston, SC, USA; Department of Medicine, Medical University of South Carolina, Charleston, SC, USA.
| |
Collapse
|
|
41
|
Rizvi A, Marcus RP, Guo Y, Carter R, Mark IT, Foley TA, Weber NM, Sheedy EN, Leng S, Williamson EE. Dynamic computed tomographic assessment of the mitral annulus in patients with and without mitral prolapse. J Cardiovasc Comput Tomogr 2020; 14:502-509. [PMID: 32253123 DOI: 10.1016/j.jcct.2020.02.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 02/07/2020] [Accepted: 02/21/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To obtain 3D CT measurements of mitral annulus throughout cardiac cycle using prototype mitral modeling software, assess interobserver agreement, and compare among patients with mitral prolapse (MP) and control group. BACKGROUND Pre-procedural imaging is critical for planning of transcatheter mitral valve (MV) replacement. However, there is limited data regarding reliable CT-based measurements to accurately characterize the dynamic geometry of the mitral annulus in patients with MV disease. METHODS Patients with MP and control subjects without any MV disease who underwent ECG-gated cardiac CT were retrospectively identified. Multiphasic CT data was loaded into a prototype mitral modeling software. Multiple anatomical parameters in 3D space were recorded throughout the cardiac cycle (0-95%): annular circumference, planar-surface-area (PSA), anterior-posterior (A-P) distance, and anterolateral-posteromedial (AL-PM) distance. Comparisons were made among the two groups, with p < 0.05 considered statistically significant. Interobserver agreement was assessed on ten patients using intraclass correlation coefficient (ICC) among 4 experienced readers. RESULTS A total of 100 subjects were included: 50 with MP and 50 control. Annular dimensions were significantly higher in the MP group than control group, with circumference (144 ± 11 vs. 117±8 mm), PSA (1533 ± 247 vs. 1005 ± 142 mm2), A-P distance (38 ± 4 vs. 32±2 mm), and AL-PM distance (47 ± 4 vs. 39±3 mm) (all p < 0.001). Substantial size changes were observed throughout the cardiac cycle, but with maximal and minimal sizes at different cardiac phases for the two groups. The interobserver agreement was excellent (ICC≥0.75) for annular circumference, PSA, A-P- and AL-PM distance. CONCLUSION A significant variation in the mitral annular measures between different cardiac phases and two groups was observed with excellent interobserver agreement.
Collapse
Affiliation(s)
- Asim Rizvi
- Department of Radiology, 200 First Street SW, Mayo Clinic, Rochester, MN, 55905, USA; Department of Medicine, The University of Texas Medical Branch at Galveston, 301 University Blvd, Galveston, TX, 77555, USA.
| | - Roy P Marcus
- Department of Radiology, 200 First Street SW, Mayo Clinic, Rochester, MN, 55905, USA.
| | - Yugene Guo
- Department of Radiology, 200 First Street SW, Mayo Clinic, Rochester, MN, 55905, USA.
| | - Rickey Carter
- Department of Health Sciences Research, 4500 San Pablo Rd S, Mayo Clinic, Jacksonville, FL, 32224, USA.
| | - Ian T Mark
- Department of Radiology, 200 First Street SW, Mayo Clinic, Rochester, MN, 55905, USA.
| | - Thomas A Foley
- Department of Radiology, 200 First Street SW, Mayo Clinic, Rochester, MN, 55905, USA.
| | - Nikkole M Weber
- Department of Radiology, 200 First Street SW, Mayo Clinic, Rochester, MN, 55905, USA.
| | - Emily N Sheedy
- Department of Radiology, 200 First Street SW, Mayo Clinic, Rochester, MN, 55905, USA.
| | - Shuai Leng
- Department of Radiology, 200 First Street SW, Mayo Clinic, Rochester, MN, 55905, USA.
| | - Eric E Williamson
- Department of Radiology, 200 First Street SW, Mayo Clinic, Rochester, MN, 55905, USA.
| |
Collapse
|
|
42
|
Wang W, Wang Z, Li J, Gong K, Zhao L, Tang G, Fu X. The impact of different geometric assumption of mitral annulus on the assessment of mitral regurgitation volume by Doppler method. Cardiovasc Ultrasound 2020; 18:5. [PMID: 32005178 PMCID: PMC6995243 DOI: 10.1186/s12947-020-0187-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 01/27/2020] [Indexed: 11/10/2022] Open
Abstract
Background Mitral regurgitation volume (MRvol) by quantitative pulsed Doppler (QPD) method previously recommended suffers from geometric assumption error because of circular geometric assumption of mitral annulus (MA). Therefore, the aim of this study was to evaluate the impact of different geometric assumption of MA on the assessment of MRvol by two-dimensional transthoracic echocardiographic QPD method. Methods This study included 88 patients with varying degrees of mitral regurgitation (MR). The MRvol was evaluated by QPD method using circular or ellipse geometric assumption of MA. MRvol derived from effective regurgitant orifice area by real time three-dimensional echocardiography (RT3DE) multiplied by MR velocity-time integral was used as reference method. Results Assumption of a circular geometry of MA, QPD-MAA4C and QPD-MAPLAX overestimated the MRvol by a mean difference of 10.4 ml (P < 0.0001) and 22.5 ml (P < 0.0001) compared with RT3DE. Assumption of an ellipse geometry of MA, there was no significant difference of MRvol (mean difference = 1.7 ml, P = 0.0844) between the QPD-MAA4C + A2C and the RT3DE. Conclusions Assuming that the MA was circular geometry previously recommended, the MRvol by QPD-MAA4C was overestimated compared with the reference method. However, assuming that the MA was ellipse geometry, the MRvol by the QPD-MAA4C + A2C has no significant difference with the reference method.
Collapse
Affiliation(s)
- Wugang Wang
- Department of Echocardiography, The Affiliated Hospital of Qingdao University, No.16 Jiangsu Road, Qingdao, 266003, China
| | - Zhibin Wang
- Department of Echocardiography, The Affiliated Hospital of Qingdao University, No.16 Jiangsu Road, Qingdao, 266003, China
| | - Junfang Li
- Department of Echocardiography, The Affiliated Hospital of Qingdao University, No.16 Jiangsu Road, Qingdao, 266003, China
| | - Kun Gong
- Department of Echocardiography, The Affiliated Hospital of Qingdao University, No.16 Jiangsu Road, Qingdao, 266003, China
| | - Liang Zhao
- Department of Echocardiography, The Affiliated Hospital of Qingdao University, No.16 Jiangsu Road, Qingdao, 266003, China
| | - Guozhang Tang
- Department of Echocardiography, The Affiliated Hospital of Qingdao University, No.16 Jiangsu Road, Qingdao, 266003, China
| | - Xiuxiu Fu
- Department of Echocardiography, The Affiliated Hospital of Qingdao University, No.16 Jiangsu Road, Qingdao, 266003, China.
| |
Collapse
|
|
43
|
Zoghbi W, Adams D, Bonow R, Enriquez-Sarano M, Foster E, Grayburn P, Hahn R, Han Y, Hung J, Lang R, Little S, Shah D, Shernan S, Thavendiranathan P, Thomas J, Weissman N. Recommendations for noninvasive evaluation of native valvular regurgitation
A report from the american society of echocardiography developed in collaboration with the society for cardiovascular magnetic resonance. JOURNAL OF THE INDIAN ACADEMY OF ECHOCARDIOGRAPHY & CARDIOVASCULAR IMAGING 2020. [DOI: 10.4103/2543-1463.282191] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
|
44
|
Han HC, Ha FJ, Teh AW, Calafiore P, Jones EF, Johns J, Koshy AN, O'Donnell D, Hare DL, Farouque O, Lim HS. Mitral Valve Prolapse and Sudden Cardiac Death: A Systematic Review. J Am Heart Assoc 2019; 7:e010584. [PMID: 30486705 PMCID: PMC6405538 DOI: 10.1161/jaha.118.010584] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background The relationship between mitral valve prolapse (MVP) and sudden cardiac death (SCD) remains controversial. In this systematic review, we evaluate the relationship between isolated MVP and SCD to better define a potential high‐risk subtype. In addition, we determine whether premortem parameters could predict SCD in patients with MVP and the incidence of SCD in MVP. Methods and Results Electronic searches were conducted in PubMed and Embase for all English literature articles published between 1960 and 2018 regarding MVP and SCD or cardiac arrest. We also identified articles investigating predictors of ventricular arrhythmias or SCD and cohort studies reporting SCD outcomes in MVP. From 2180 citations, there were 79 articles describing 161 cases of MVP with SCD or cardiac arrest. The median age was 30 years and 69% of cases were female. Cardiac arrest occurred during situations of stress in 47% and was caused by ventricular fibrillation in 81%. Premature ventricular complexes on Holter monitoring (92%) were common. Most cases had bileaflet involvement (70%) with redundancy (99%) and nonsevere mitral regurgitation (83%). From 22 articles describing predictors for ventricular arrhythmias or SCD in MVP, leaflet redundancy was the only independent predictor of SCD. The incidence of SCD with MVP was estimated at 217 events per 100 000 person‐years. Conclusions Isolated MVP and SCD predominantly affects young females with redundant bileaflet prolapse, with cardiac arrest usually occurring as a result of ventricular arrhythmias. To better understand the complex relationship between MVP and SCD, standardized reporting of clinical, electrophysiological, and cardiac imaging parameters with longitudinal follow‐up is required.
Collapse
Affiliation(s)
- Hui-Chen Han
- 1 Department of Cardiology Austin Health University of Melbourne Melbourne Australia
| | - Francis J Ha
- 1 Department of Cardiology Austin Health University of Melbourne Melbourne Australia
| | - Andrew W Teh
- 1 Department of Cardiology Austin Health University of Melbourne Melbourne Australia.,3 Department of Cardiology Eastern Health Monash University Melbourne Australia
| | - Paul Calafiore
- 1 Department of Cardiology Austin Health University of Melbourne Melbourne Australia
| | - Elizabeth F Jones
- 1 Department of Cardiology Austin Health University of Melbourne Melbourne Australia
| | - Jennifer Johns
- 1 Department of Cardiology Austin Health University of Melbourne Melbourne Australia
| | - Anoop N Koshy
- 1 Department of Cardiology Austin Health University of Melbourne Melbourne Australia
| | - David O'Donnell
- 1 Department of Cardiology Austin Health University of Melbourne Melbourne Australia
| | - David L Hare
- 1 Department of Cardiology Austin Health University of Melbourne Melbourne Australia
| | - Omar Farouque
- 1 Department of Cardiology Austin Health University of Melbourne Melbourne Australia
| | - Han S Lim
- 1 Department of Cardiology Austin Health University of Melbourne Melbourne Australia.,2 Department of Cardiology Northern Health University of Melbourne Melbourne Australia
| |
Collapse
|
|
45
|
Farrag HMA, Setouhi AM, El-Mokadem MO, El-Swasany MA, Mahmoud KS, Mahmoud HB, Ibrahim AM. Additive value of 3D-echo in prediction of immediate outcome after percutaneous balloon mitral valvuloplasty. Egypt Heart J 2019; 71:19. [PMID: 31659518 PMCID: PMC6821434 DOI: 10.1186/s43044-019-0019-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 08/23/2019] [Indexed: 11/22/2022] Open
Abstract
Background Results of percutaneous balloon mitral valvuloplasty (BMV) are basically dependent on suitable patient selection. Currently used two-dimensional (2D) echocardiography (2DE) scores have many limitations. Three-dimensional (3D) echocardiography (3DE)-based scores were developed for better patient selection and outcome prediction. We aimed to compare between 3D-Anwar and 2D-Wilkins scores in mitral assessment for BMV, and investigate the additive value of 3DE in prediction of immediate post-procedural outcome. Fifty patients with rheumatic mitral stenosis and candidates for BMV were included. Patients were subjected to 2D- and real-time 3D-transthoracic echocardiography (TTE) before and immediately after BMV for assessing MV area (MVA), 2D-Wilkins and 3D-Anwar score, commissural splitting, and mitral regurgitation (MR). Transesophageal echocardiography (TEE) was also undertaken immediately before and intra-procedural. Percutaneous BMV was performed by either multi-track or Inoue balloon technique. Results The 2DE underestimated post-procedural MVA than 3DE (p = 0.008). Patients with post-procedural suboptimal MVA or significant MR had higher 3D-Anwar score compared to 2D-Wilkins score (p = 0.008 and p = 0.03 respectively). The 3D-Anwar score showed a negative correlation with post-procedural MVA (r = − 0.48, p = 0.001). Receiver operating characteristic (ROC) curve analysis for both scores revealed superior prediction of suboptimal results by 3D-Anwar score (p < 0.0001). The 3DE showed better post-procedural posterior-commissural splitting than 2DE (p = 0.004). Results of both multi-track and Inoue balloon were comparable except for favorable posterior-commissural splitting by multi-track balloon (p = 0.04). Conclusion The 3DE gave valuable additive data before BMV that may predict immediate post-procedural outcome and suboptimal results. Electronic supplementary material The online version of this article (10.1186/s43044-019-0019-x) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Hazem M A Farrag
- Cardiology Department, Faculty of Medicine, Minia University, Minya, 61111, Egypt.
| | - Amr M Setouhi
- Cardiology Department, Faculty of Medicine, Minia University, Minya, 61111, Egypt
| | - Mustafa O El-Mokadem
- Cardiology Department, Faculty of Medicine, Beni-Suef University, Beni Suef, Egypt
| | | | - Khalid S Mahmoud
- Cardiology Department, Faculty of Medicine, Minia University, Minya, 61111, Egypt
| | - Hesham B Mahmoud
- Cardiology Department, Faculty of Medicine, Beni-Suef University, Beni Suef, Egypt
| | - Alaa M Ibrahim
- Cardiology Department, Faculty of Medicine, Minia University, Minya, 61111, Egypt
| |
Collapse
|
|
46
|
Faletra FF, Leo LA, Paiocchi VL, Caretta A, Viani GM, Schlossbauer SA, Demertzis S, Ho SY. Anatomy of mitral annulus insights from non-invasive imaging techniques. Eur Heart J Cardiovasc Imaging 2019; 20:843-857. [DOI: 10.1093/ehjci/jez153] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 05/21/2019] [Indexed: 01/02/2023] Open
Abstract
AbstractThe mitral annulus (MA) is not a continuous ring of connective tissue from which are suspended mitral leaflets. Instead, it is a much more complex structure made up of a mix of fibrous, muscular, and adipose tissues. MA is a key structure in any type of mitral valve repair and recently it has been targeted for transcutaneous devices. Thus, a deep understanding of MA anatomy has never been more important. Traditionally, cardiac anatomy has been described using anatomic specimens. Currently, sophisticated non-invasive techniques allow imaging of MA with a richness of anatomical details unimaginable only two decades ago. The aim of this review is to provide a better understanding of the peculiar aspects of MA as they are revealed through these imaging techniques and discuss clinical implications related to this complex structure.
Collapse
Affiliation(s)
- Francesco F Faletra
- Department of Cardiology Fondazione, Cardiocentro Ticino Lugano, Via Tesserete 48, CH Lugano, Switzerland
| | - Laura Anna Leo
- Department of Cardiology Fondazione, Cardiocentro Ticino Lugano, Via Tesserete 48, CH Lugano, Switzerland
| | - Vera Lucia Paiocchi
- Department of Cardiology Fondazione, Cardiocentro Ticino Lugano, Via Tesserete 48, CH Lugano, Switzerland
| | - Alessandro Caretta
- Department of Cardiology Fondazione, Cardiocentro Ticino Lugano, Via Tesserete 48, CH Lugano, Switzerland
| | - Giacomo Maria Viani
- Department of Cardiology Fondazione, Cardiocentro Ticino Lugano, Via Tesserete 48, CH Lugano, Switzerland
| | - Susanne Anna Schlossbauer
- Department of Cardiology Fondazione, Cardiocentro Ticino Lugano, Via Tesserete 48, CH Lugano, Switzerland
| | - Stefanos Demertzis
- Department of Cardiology Fondazione, Cardiocentro Ticino Lugano, Via Tesserete 48, CH Lugano, Switzerland
| | - Siew Yen Ho
- Cardiac Morphology Unit, Royal Brompton and Harefield NHS Foundation Trust and Imperial College London, London, UK
| |
Collapse
|
|
47
|
Pitsis A, Kelpis T, Theofilogiannakos E, Tsotsolis N, Boudoulas H, Boudoulas KD. Mitral valve repair: moving towards a personalized ring. J Cardiothorac Surg 2019; 14:108. [PMID: 31196216 PMCID: PMC6567592 DOI: 10.1186/s13019-019-0926-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Accepted: 06/03/2019] [Indexed: 11/10/2022] Open
Abstract
Background Mitral valve repair with the use of an annuloplasty ring is the procedure of choice in patients with significant mitral regurgitation (MR) due to floppy mitral valve (FMV)/mitral valve prolapse (MVP). The mitral annular size, shape and motion may vary substantially among patients and thus, commercially available rings may not be suitable for each individual patient. Methods A “personalized ring” (PR) was easily constructed in the operating room using a Dacron sheet and titanium ligating clips to custom fit to each individual mitral annulus shape and size. There were 127 patients with severe MR due to FMV/MVP that underwent mitral valve repair surgery; 58 patients received a PR and 69 patients received a commercial Carpentier-Edwards Physio II ring. The patient records were retrospectively analysed. Results There were no surgical deaths. In-hospital length-of-stay and blood transfusions were not statistically different between the two groups. Mitral valve area was greater (p < 0.05) in the PR group (3.78 ± 0.22) compared to the Physio II ring group (3.13 ± 0.21). Mitral annular area changed from systole to diastole by 14.35% ± 3.28% in the PR group and did not change in the Physio II ring group (p < 0.05). Systolic anterior motion (SAM) of the mitral valve occurred in 2 patients with the Physio II ring and no patients with the PR. Up to 8 years follow-up, all patients in both groups were alive with NYHA functional class I-II symptoms and mild or less MR. Conclusions The PR is suitable for all patients with significant MR due to FMV/MVP who require MV repair. The precise fit of the PR to the mitral annulus better preserves valve area and sphincter function of the mitral annulus, prevents SAM and provides excellent short and long-term results.
Collapse
Affiliation(s)
- Antonios Pitsis
- Department of Cardiac Surgery, St. Luke's Hospital, Thessaloniki, Greece.
| | - Timotheos Kelpis
- Department of Cardiac Surgery, St. Luke's Hospital, Thessaloniki, Greece
| | | | - Nikolaos Tsotsolis
- Department of Cardiac Surgery, St. Luke's Hospital, Thessaloniki, Greece
| | - Harisios Boudoulas
- Department of Medicine, Division of Cardiovascular Medicine, The Ohio State University, Columbus, OH, USA
| | | |
Collapse
|
|
48
|
Kimura T, Roger VL, Watanabe N, Barros-Gomes S, Topilsky Y, Nishino S, Shibata Y, Enriquez-Sarano M. The unique mechanism of functional mitral regurgitation in acute myocardial infarction: a prospective dynamic 4D quantitative echocardiographic study. Eur Heart J Cardiovasc Imaging 2019; 20:396-406. [PMID: 30517693 PMCID: PMC6429236 DOI: 10.1093/ehjci/jey177] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 09/27/2018] [Accepted: 10/31/2018] [Indexed: 02/06/2023] Open
Abstract
AIMS Mechanisms of chronic ischaemic mitral regurgitation (IMR) are well-characterized by apically tethered leaflet caused by papillary muscles (PMs) displacement and adynamic mitral apparatus. We investigated the unique geometry and dynamics of the mitral apparatus in first acute myocardial infarction (MI) by using quantified 3D echocardiography. METHODS AND RESULTS We prospectively performed 3D echocardiography 2.3 ± 1.8 days after first MI, in 174 matched patients with (n = 87) and without IMR (n = 87). 3D echocardiography of left ventricular (LV) volumes and of mitral apparatus dynamics throughout cardiac cycle was quantified. Similar mitral quantification was obtained at chronic post-MI stage (n = 44). Mechanistically, acute IMR was associated with larger and flatter annulus (area 9.29 ± 1.74 cm2 vs. 8.57 ± 1.94 cm2, P = 0.002, saddle shape 12.7 ± 4.5% vs. 15.0 ± 4.6%, P = 0.001), and larger tenting (length 6.36 ± 1.78 mm vs. 5.60 ± 1.55 mm, P = 0.003) but vs. chronic MI, mitral apparatus displayed smaller alterations (all P < 0.01) and annular size, PM movement remained dynamic (all P < 0.01). Specific to acute IMR, without PM apical displacement (P > 0.70), greater separation (21.7 ± 4.9 mm vs. 20.0 ± 3.4 mm, P = 0.01), and widest angulation of PM (38.4 ± 6.2° for moderate vs. 33.5 ± 7.3° for mild vs. 31.4 ± 6.3° for no-IMR, P = 0.0009) wider vs. chronic MI (P < 0.01). CONCLUSIONS 3D echocardiography of patients with first MI provides insights into unique 4D dynamics of the mitral apparatus in acute IMR. Mitral apparatus remained dynamic in acute MI and distinct IMR mechanism in acute MI is not PM displacement seen in chronic IMR but separation and excess angulation of PM deforming the mitral valve, probably because of sudden-onset regional wall motion abnormality without apparent global LV remodelling. This specific mechanism should be considered in novel therapeutic strategies for IMR complicating acute MI.
Collapse
Affiliation(s)
- Toshiyuki Kimura
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN, USA
- Department of Cardiology, Miyazaki Medical Association Hospital, Funado, Shinbeppu-chou, Miyazaki city, Miyazaki, Japan
| | - Véronique L Roger
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN, USA
- Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN, USA
| | - Nozomi Watanabe
- Department of Cardiology, Miyazaki Medical Association Hospital, Funado, Shinbeppu-chou, Miyazaki city, Miyazaki, Japan
| | - Sergio Barros-Gomes
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN, USA
| | - Yan Topilsky
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN, USA
- Department of Cardiovascular Diseases, Tel Aviv Medical Center, 6 Weizmann Street, Tel Aviv, Israel
| | - Shun Nishino
- Department of Cardiology, Miyazaki Medical Association Hospital, Funado, Shinbeppu-chou, Miyazaki city, Miyazaki, Japan
| | - Yoshisato Shibata
- Department of Cardiology, Miyazaki Medical Association Hospital, Funado, Shinbeppu-chou, Miyazaki city, Miyazaki, Japan
| | | |
Collapse
|
|
49
|
Affiliation(s)
- Aeshah Althunayyan
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, London, UK
- William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Steffen E Petersen
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, London, UK
- William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Guy Lloyd
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, London, UK
- William Harvey Research Institute, Queen Mary University of London, London, UK
- Institute of Cardiovascular Sciences, UCL, London, UK
| | - Sanjeev Bhattacharyya
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, London, UK
- William Harvey Research Institute, Queen Mary University of London, London, UK
- Institute of Cardiovascular Sciences, UCL, London, UK
| |
Collapse
|
|
50
|
Menciotti G, Borgarelli M, Aherne M, Camacho P, Häggström J, Ljungvall I, Lahmers SM, Abbott JA. Comparison of the mitral valve morphologies of Cavalier King Charles Spaniels and dogs of other breeds using 3D transthoracic echocardiography. J Vet Intern Med 2018; 32:1564-1569. [PMID: 30238697 PMCID: PMC6189382 DOI: 10.1111/jvim.15252] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 04/25/2018] [Accepted: 05/31/2018] [Indexed: 11/30/2022] Open
Abstract
Background Myxomatous mitral valve disease (MMVD) is more prevalent in Cavalier King Charles Spaniels (CKCSs) compared to dogs of other breeds at a given age. Abnormal valvular stress is thought to contribute to the development and progression of MMVD, and a relationship exists between mitral valve (MV) morphology and stress acting on the valve. Objectives To determine whether the MV morphology of healthy adult CKCSs differs from the morphology of healthy adult dogs of other breeds determined by RT‐3DTTE. Animals Thirty‐five healthy CKCSs and 41 healthy dogs of other breeds. Methods Prospective cross‐sectional study. Dogs underwent physical examination, conventional echocardiography, and RT‐3DTTE. RT–3DTTE datasets were analyzed using dedicated software for MV morphologic analysis. Morphologic variables were compared between CKCSs and dogs of other breeds. Results The MV of healthy CKCSs had a smaller annulus height (0.46 ± 0.11 vs. 0.56 ± 0.17; P = .0021), tenting height (0.26 ± 0.12 vs. 0.42 ± 0.18; P < .001), tenting area (0.42 ± 0.15 vs. 0.79 ± 0.34; P < .001), normalized tenting volume (0.09 [0.05–0.13] vs. 0.14 [0.10–0.20]; P < .001), and normalized area of the posterior leaflet (0.57 ± 0.15 vs. 0.66 ± 0.18; P = .016) compared to healthy dogs of other breeds; this results in CKCSs having a flatter MV with reduced tenting, compared to the MV of other breeds. Conclusions and Clinical Importance These morphologic features could confer a mechanical disadvantage and play a role in the predisposition of CKCSs to the early development of MMVD.
Collapse
Affiliation(s)
- Giulio Menciotti
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Blacksburg, Virginia
| | - Michele Borgarelli
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Blacksburg, Virginia
| | - Michael Aherne
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Blacksburg, Virginia
| | - Paula Camacho
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Blacksburg, Virginia
| | - Jens Häggström
- Department of Clinical Sciences, Swedish University of Agricultural Science, Uppsala, Sweden
| | - Ingrid Ljungvall
- Department of Clinical Sciences, Swedish University of Agricultural Science, Uppsala, Sweden
| | - Sunshine M Lahmers
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Blacksburg, Virginia
| | - Jonathan A Abbott
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Blacksburg, Virginia
| |
Collapse
|