Basic Mechanisms of Mitral Regurgitation

Dal‐Bianco, Jacob P.; Beaudoin, Jonathan; Handschumacher, Mark D.; Levine, Robert A.

doi:10.1016/j.cjca.2014.06.022

Cited by 56 publications

(43 citation statements)

References 135 publications

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“…87–89 Additional assessment focuses on leaflet displacement relative to each other, leading to malcoaptation. 90,91 New diagnostic criteria have revised the prevalence of MVP to 2.4% without loss of sensitivity. 81 Improved diagnostic specificity has also provided a firm foundation for genetic studies of this frequently inherited disease.…”

Section: Mitral Valve Prolapsementioning

confidence: 99%

“…SAM has two main consequences: firstly, flow is accelerated within the narrowed LVOT, creating a pressure gradient measurable by Doppler echocardiography; and secondly, disruption of normal leaflet coaptation, causing mitral regurgitation of variable severity. 91,180 Subaortic obstruction is present in two‐thirds of patients at rest or with exercise, and leads to symptoms of, and predicts progression to, heart failure and sudden cardiac death. 181,182 …”

Section: Mitral Valve In Hcmmentioning

confidence: 99%

See 1 more Smart Citation

Mitral valve disease—morphology and mechanisms

Levine¹,

Hagège²,

Judge³

et al. 2015

Nat Rev Cardiol

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319

254

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Mitral valve disease is a frequent cause of heart failure and death. Emerging evidence indicates that the mitral valve is not a passive structure, but—even in adult life—remains dynamic and accessible for treatment. This concept motivates efforts to reduce the clinical progression of mitral valve disease through early detection and modification of underlying mechanisms. Discoveries of genetic mutations causing mitral valve elongation and prolapse have revealed that growth factor signalling and cell migration pathways are regulated by structural molecules in ways that can be modified to limit progression from developmental defects to valve degeneration with clinical complications. Mitral valve enlargement can determine left ventricular outflow tract obstruction in hypertrophic cardiomyopathy, and might be stimulated by potentially modifiable biological valvular–ventricular interactions. Mitral valve plasticity also allows adaptive growth in response to ventricular remodelling. However, adverse cellular and mechanobiological processes create relative leaflet deficiency in the ischaemic setting, leading to mitral regurgitation with increased heart failure and mortality. Our approach, which bridges clinicians and basic scientists, enables the correlation of observed disease with cellular and molecular mechanisms, leading to the discovery of new opportunities for improving the natural history of mitral valve disease.

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Section: Mitral Valve Prolapsementioning

confidence: 99%

Section: Mitral Valve In Hcmmentioning

confidence: 99%

Mitral valve disease—morphology and mechanisms

Levine¹,

Hagège²,

Judge³

et al. 2015

Nat Rev Cardiol

Self Cite

319

254

View full text Add to dashboard Cite

show abstract

“…A delicate balance is maintained between tethering forces (transmitted via the left ventricular wall, papillary muscles and chordae tendineae system influenced by annular/leaflet dimensions) and valve closing forces (left ventricular contractility and synchrony, mitral annular systolic contraction). Disruption in any of these mechanisms may unsettle the force balance and result in MR 11 .…”

Section: Pathophysiologymentioning

confidence: 99%

Exercise Dynamics in Secondary Mitral Regurgitation

et al. 2017

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Secondary mitral valve regurgitation (MR) remains a challenging problem in the diagnostic work-up and treatment of heart failure patients. Although secondary MR is characteristically dynamic in nature and sensitive to changes in ventricular geometry and loading, current therapy is mainly focused on resting conditions. Exercise-induced increase in secondary MR, however, is associated with impaired exercise capacity and increased mortality. In an era where a multitude of percutaneous solutions are emerging for the treatment of HF patients it becomes important to address the dynamic component of secondary MR during exercise as well. A critical reappraisal of the underlying disease mechanisms, and in particular of the dynamic component during exercise is of timely importance. This review summarizes the pathophysiologic mechanisms involved in the dynamic deterioration of secondary MR during exercise, its functional and prognostic impact, and the way current treatment options affect the dynamic lesion and exercise hemodynamics in general.

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“…Functional mitral regurgitation is characterized by tethering of the leaflets, and a jet that is usually central or posteriorly directed in the absence of anterior leaflet prolapse. Ischemic mitral regurgitation may also be associated with a commissural jet, related to loss of support from one or the other papillary muscle (30). Even when mitral regurgitation is not severe, the spectral Doppler jet provides information about LV function; the rate of increase of velocity is analogous to the measurement of LV dP/dt (normally .…”

Section: Mitral Regurgitationmentioning

confidence: 99%

The Role of Echocardiography in Heart Failure

Marwick¹

2015

J Nucl Med

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Data from echocardiography provide a cornerstone in the management of heart failure. All imaging techniques can provide an ejection fraction, but the versatility of echocardiography makes it unique in the provision of volumes, diastolic function, right ventricular function, hemodynamics, and valvular regurgitation. The early detection of heart failure has been facilitated by the assessment of global longitudinal strain, which is also useful in later heart failure for the assessment of left ventricular synchrony. The use of echocardiography has been associated with favorable outcomes, probably on the basis of facilitation of appropriate therapy. This review examines the evidence provided by echocardiography and its application in specific settings. Although the guidelines emphasize that no single test satisfies all imaging requirements in heart failure, and other modalities can provide additional information about specific questions (especially tissue characterization), echocardiography is indispensable in the management of heart failure.

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Basic Mechanisms of Mitral Regurgitation

Cited by 56 publications

References 135 publications

Mitral valve disease—morphology and mechanisms

Mitral valve disease—morphology and mechanisms

Exercise Dynamics in Secondary Mitral Regurgitation

The Role of Echocardiography in Heart Failure

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