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Related Concept Videos

Mitral Regurgitation I: Introduction01:20

Mitral Regurgitation I: Introduction

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Mitral regurgitation is characterized by the backward circulation of blood from the left ventricle to the left atrium during systole, a phase of the cardiac cycle when the heart contracts and pumps blood out of the chambers. This abnormal flow occurs primarily due to the dysfunction of the mitral valve or its supporting structures, which include the mitral leaflets, chordae tendineae, annulus, and papillary muscles.Etiology and Mechanisms:Primary Mitral Regurgitation: This type arises from...
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Mitral Stenosis I: Introduction01:22

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Mitral Valve Stenosis (MVS) is a heart condition where the mitral valve narrows, impeding blood circulation from the left atrium to the left ventricle. The etiology and pathophysiology of this condition are multifaceted, leading to a cascade of cardiovascular complications.Causes of Mitral Valve StenosisRheumatic Heart Disease: It is the main cause of mitral valve stenosis, particularly in developing nations. This condition arises from rheumatic fever, an inflammatory illness resulting from...
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Mitral Regurgitation III: Medical Management01:25

Mitral Regurgitation III: Medical Management

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Mitral regurgitation (MR) is characterized by retrograde blood circulation from the left ventricle into the left atrium due to inadequate mitral valve closure. The severity of the condition, symptoms, and underlying cause determine treatment strategies.Monitoring and Pharmacological TreatmentPatients with mild to moderate MR typically do not need immediate intervention but regular monitoring to assess progression and guide treatment. Patients with mild MR should have an echocardiogram every 3-5...
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Mitral Stenosis II: Clinical features and Diagnostic Tests01:23

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Mitral stenosis is a heart condition in which the mitral valve, which allows blood to flow from the left atrium to the left ventricle, becomes narrowed or stenotic. This narrowing hinders blood flow and leads to clinical symptoms requiring specific medical evaluations and management strategies. The following overview outlines the clinical symptoms, assessments, diagnostic findings, prevention methods, and treatments for mitral stenosis.Clinical ManifestationsDyspnea (shortness of breath): This...
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Mitral Regurgitation II: Clinical Features and Diagnostic Tests01:23

Mitral Regurgitation II: Clinical Features and Diagnostic Tests

381
Mitral regurgitation (MR) is a valvular heart disorder in which the mitral valve fails to close tightly, allowing blood to leak backward into the heart. Understanding the clinical manifestations, assessment, diagnostic findings, and medical management of MR is crucial to effectively managing affected patients.Clinical Manifestations of Mitral RegurgitationMitral regurgitation can be acute or chronic, each presenting differently and requiring different approaches:1. Acute Mitral...
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Mitral Valve Prolapse I: Introduction01:27

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IntroductionThe mitral valve, one of the heart's four valves, regulates blood flow. These valves have flaps that open and close to direct blood properly through the heart and body. During each heartbeat, the flaps open for blood to pass through and seal shut to prevent backflow. Specifically, the mitral valve opens to allow blood flow from the heart's upper left chamber to the lower left chamber. It then closes securely as the lower left chamber contracts to pump blood to the body, preventing...
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Mitral Annular Function in Mitral Annular Calcification and Severe Mitral Regurgitation.

Joseph Kassab1, Joseph Hajj2, Serge C Harb2

  • 1Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA; Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas, USA.

JACC. Advances
|September 18, 2025
PubMed
Summary

Cardiac CT effectively measures mitral annular function and its role in stroke volume. Moderate-to-severe mitral annular calcification (MAC) significantly impairs this function, impacting left ventricular stroke volume (LVSV).

Keywords:
mitral annular calcificationmitral annular functionmitral regurgitationtranscatheter mitral valve replacement

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Area of Science:

  • Cardiology
  • Medical Imaging
  • Cardiac Mechanics

Background:

  • Longitudinal left ventricular (LV) shortening, known as mitral atrioventricular plane displacement (AVPD), is a key indicator of mitral annular function.
  • Assessing AVPD and its contribution to LV stroke volume (LVSV) is crucial for understanding cardiac performance.

Purpose of the Study:

  • To demonstrate the utility of cardiac computed tomography (CCT) in measuring mitral AVPD.
  • To evaluate the contribution of mitral AVPD to LVSV in patients with mitral annular calcification (MAC), severe functional mitral regurgitation (FMR), and severe primary mitral regurgitation (PMR).

Main Methods:

  • CCT was performed on 200 patients with MAC, 50 with severe FMR, 50 with severe PMR, and 50 controls.
  • Mitral AVPD was measured, and its volume (VAVPD) and fractional contribution to LVSV (SVAVPD%) were calculated.
  • Statistical analyses, including t-tests, ANOVA, Chi-square tests, and multivariable linear regression, were employed.

Main Results:

  • Mean AVPD varied significantly across groups (controls, PMR, FMR), but SVAVPD% was similar.
  • In MAC patients, AVPD decreased with increasing calcification severity.
  • Severe MAC (grade 3-4) was associated with significantly lower SVAVPD% compared to non-MAC groups, with MAC severity independently linked to reduced AVPD and SVAVPD%.

Conclusions:

  • CCT is a viable tool for quantifying mitral annular function and its impact on LVSV.
  • Moderate-to-severe MAC substantially diminishes mitral annular function, reducing its contribution to LVSV.
  • These findings can guide patient selection for transcatheter mitral therapies affecting annular dynamics.