Mitral annulus morphometry in degenerative mitral regurgitation phenotypes
Giacomo Maria Viani1, Laura Anna Leo1, Maria Giuliana Borruso1
1Fondazione Cardiocentro Ticino, Lugano, Switzerland.
Echocardiography (Mount Kisco, N.Y.)
|April 1, 2020
Summary
Degenerative mitral regurgitation (DMR) phenotypes correlate with mitral annulus (MA) abnormalities. More complex DMR phenotypes show greater MA enlargement, flattening, and prolapse, particularly in Barlow's disease with mitral annular disjunction (BD MAD+).
Area of Science:
- Cardiology
- Cardiac Imaging
- Structural Heart Disease
Background:
- Degenerative mitral regurgitation (DMR) exhibits diverse phenotypes based on leaflet degeneration.
- Understanding the structural impact on the mitral annulus (MA) is crucial for characterizing DMR severity.
Purpose of the Study:
- To determine if DMR phenotype complexity predicts the extent of structural abnormalities in the mitral annulus (MA).
Main Methods:
- Utilized 3D transesophageal echocardiography in 75 DMR patients and 23 controls.
- Classified DMR into five phenotypes: FED, FED+, forme fruste, BD MAD-, and BD MAD+.
- Analyzed MA dimensions and dynamics in early and end systole.
Main Results:
- A significant trend of increasing MA anteroposterior diameter, intercommissural diameter, circumference, and area was observed with worsening DMR phenotype (P < .001).
- Progressive MA flattening was indicated by a reduced annulus height to commissural width ratio (P = .003).
- Prolapse height and volume increased significantly with DMR complexity (P < .001).
Conclusions:
- DMR phenotype complexity is a predictor of MA structural abnormalities.
- Disease progression leads to increased MA size, altered shape (loss of saddle shape), and augmented leaflet prolapse.
- Barlow's disease with mitral annular disjunction (BD MAD+) demonstrates the most severe MA alterations.
Keywords:
mitral regurgitationmitral valvemitral valve prolapsethree-dimensional echocardiographytransesophageal echocardiographyMore Related Videos
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