Evidence of a Vicious Cycle in Mitral Regurgitation With Prolapse

Otani, Kyoko; Takeuchi, Masaaki; Kaku, Kyoko; Haruki, Nobuhiko; Yoshitani, Hidetoshi; Eto, Masataka; Tamura, Masahito; Okazaki, Masahiro; Abe, Haruhiko; Fujino, Yoshihisa; Nishimura, Yukio; Levine, Robert A.; Otsuji, Yutaka

doi:10.1161/circulationaha.111.084178

Cited by 28 publications

(41 citation statements)

References 38 publications

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“…18 Primary MR causes secondary LV dilatation, which further promotes MR by secondary MV tethering. 19 This study demonstrated a novel LV and MV interaction in which MV annular dilatation can be associated with basal LV dilatation and reduced contraction. In addition to the potential role of MV annular dilatation to exacerbate MR, 20 this study further demonstrated its role to dilate LV base and reduce its contraction.…”

Section: Correlation With Previous Investigationsmentioning

confidence: 66%

Basal Left Ventricular Dilatation and Reduced Contraction in Patients With Mitral Valve Prolapse Can Be Secondary to Annular Dilatation

Fukuda

Song

Mahara

et al. 2016

Circ: Cardiovascular Imaging

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Background— Prominent mitral valve (MV) annular dilatation with only modest left ventricular (LV) dilatation in patients with MV prolapse (MVP) suggests predominant dilatation in adjacent basal LV, which may augment regional wall tension and attenuate contraction by Laplace’s law. We hypothesized that MV annular dilatation in patients with MVP is associated with the basal predominance of LV dilatation and attenuated contraction, which can be altered by surgical MV plasty with annulus reduction. Methods and Results— Echocardiography with speckle-tracking analysis to assess regional cross-sectional short-axis area and longitudinal contraction (strain) of basal, middle, and apical LV was performed in 30 controls and 130 patients with MVP. The basal value/averaged middle and apical values (B/M·A ratio) of LV cross-sectional area and strain were obtained. Patients with MVP showed significantly greater MV annular area (6.4±1.6 versus 3.7±0.6 cm 2 /m 2 ), increased B/M·A LV area ratio (2.4±0.5 versus 1.8±0.2), and reduced B/M·A LV strain ratio (0.83±0.14 versus 0.96±0.09) than controls ( P <0.001). Multivariable analyses identified that MV annular dilatation was independently associated with increased B/M·A LV area ratio (β=0.60, P <0.001), which was associated with reduced B/M·A LV strain ratio (β=−0.32, P <0.001). In 35 patients with MVP, B/M·A LV area and strain ratio significantly altered after surgical MV plasty with annulus reduction (2.5±0.5–1.8±0.3 and 0.73±0.10–0.89±0.17, P <0.001, respectively). Conclusions— In patients with MVP, MV annular dilatation was associated with the basal predominance of LV dilatation and reduced contraction, which can be altered by surgical MV plasty with annulus reduction, suggesting unfavorable influence from MV annular dilatation on basal LV.

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Section: Correlation With Previous Investigationsmentioning

confidence: 66%

Basal Left Ventricular Dilatation and Reduced Contraction in Patients With Mitral Valve Prolapse Can Be Secondary to Annular Dilatation

Fukuda

Song

Mahara

et al. 2016

Circ: Cardiovascular Imaging

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“…20,21 A quantitative RT3DE study performed by Otani et al showed that the nonprolapsed MV leaflets are often apically tethered as a result of LV dilatation attributed to primary MVP-associated MR, and that secondary tethering further exacerbates malcoaptation and contributes to a vicious cycle begetting more MR ( Figure 4B). 22 In P2 prolapse, AL tenting volume shows good correlation with left ventricular midsystolic volume and papillary muscle displacement. Multivariate analysis has identified both leaflet tenting volume and prolapse (1) RT or live 3D imaging and (2) gated acquisition with non-RT reconstruction.…”

Section: Subvalvular Apparatusmentioning

confidence: 83%

Quantification of Mitral Valve Morphology With Three-Dimensional Echocardiography

Lee

Fang

Jin

et al. 2014

Circ J

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Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp ysis yields faster and more reproducible results; and (4) a variety of users (eg, cardiac anesthetists) wants to use the repeatable methodology offered by quantitative methods. Image-processing tools provide characterization of the complex 3D morphology and motion of the MV. Combined with the properties of the imaging modality and knowledge of anatomy, this yields quantitative descriptions that are useful in diagnostic and therapeutic decision-making. This review summarizes the current development and applications of quantitative analysis of the MV morphology using RT3DE. Anatomic Consideration MV LeafletsThe anterior leaflet (AL) is in fibrous continuity with the aortic valve and guards one-third of the anterior mitral annulus. Fine demarcations divide the AL into 3 smaller scallops. The posterior leaflet (PL) is crescent-shaped and spans the posterior n the past 5 years, advances in real-time 3-dimensional echocardiography (RT3DE) have revolutionized the imaging of the mitral valve (MV). Many studies have consistently shown the superiority of 3D transesophageal echocardiography (TEE) over 2D TEE for visualizing MV morphology. 1 RT3DE has become the imaging modality of choice for guiding MV surgery and catheter-based intervention. Currently, RT3D imaging of the MV involves mainly visualization and qualitative interpretation of volume-rendered images. This "qualitative" approach typically involves few quantitative measurements of MV morphology, and is prone to subjectivity that introduces bias, low reproducibility, and high dependency on imaging expertise.Quantitative cardiac imaging has growing importance for several reasons: (1) as imaging becomes more digital, the opportunity will create the need; (2) automated approaches to intervention and surgery design and planning are emerging from the laboratory and entering the clinic; (3) algorithm-driven anal- The mitral valve (MV) has complex 3-dimensional (3D) morphology and motion. Advance in real-time 3D echocardiography (RT3DE) has revolutionized clinical imaging of the MV by providing clinicians with realistic visualization of the valve. Thus far, RT3DE of the MV structure and dynamics has adopted an approach that depends largely on subjective and qualitative interpretation of the 3D images of the valve, rather than objective and reproducible measurement. RT3DE combined with image-processing computer techniques provides precise segmentation and reliable quantification of the complex 3D morphology and rapid motion of the MV. This new approach to imaging may provide additional quantitative descriptions that are useful in diagnostic and therapeutic decision-making. Quantitative analysis of the MV using RT3DE has increased our understanding of the pathologic mechanism of degenerative, ischemic, functional, and rheumatic MV disease. Most recently, 3D morphologic quantification has entered into clinical use to provide more accurate diagnosis of MV disease and for plannin...

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“…Left ventricular dilatation may cause papillary muscle displacement, which further exacerbates mitral regurgitation resulting in a vicious cycle. Atrial fibrillation may also increase the severity of mitral regurgitation that improves after restoration of sinus rhythm [1,2,41,42,43,44,45]. When FMV/MVP is part of a recognized heritable connective tissue disorder or when it is associated with other cardiovascular abnormalities, the natural history may mostly be related to the underlying disease rather than FMV/MVP per se [1,2].…”

Section: Classificationmentioning

confidence: 99%

Floppy Mitral Valve (FMV)/Mitral Valve Prolapse (MVP) and the FMV/MVP Syndrome: Pathophysiologic Mechanisms and Pathogenesis of Symptoms

Boudoulas¹,

Boudoulas

2013

Cardiology

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Mitral valve prolapse (MVP) results from the systolic movement of a portion or segments of the mitral valve leaflets into the left atrium during left ventricular systole. It is well appreciated today that floppy mitral valve (FMV) is the central issue in the MVP and mitral valve regurgitation (MVR) story. The term FMV refers to the expansion of the area of the mitral valve leaflets with elongated chordae tendineae, chordae rupture and mitral annular dilation. FMV/MVP occurs in a heterogeneous group of patients with a wide spectrum of mitral valve involvement from mild to severe. Two types of symptoms can be defined in FMV/MVP patients. In one group of patients, symptoms are directly related to progressive MVR. In the other group, symptoms cannot be explained by the degree of MVR alone; activation of the autonomic nervous system has been implicated for the explanation of symptoms in this group of patients which is referred to as the FMV/MVP syndrome. In this brief review, the natural history, pathophysiologic mechanisms and management of patients with FMV/MVP/MVR and FMV/MVP syndrome are discussed.

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Evidence of a Vicious Cycle in Mitral Regurgitation With Prolapse

Cited by 28 publications

References 38 publications

Basal Left Ventricular Dilatation and Reduced Contraction in Patients With Mitral Valve Prolapse Can Be Secondary to Annular Dilatation

Basal Left Ventricular Dilatation and Reduced Contraction in Patients With Mitral Valve Prolapse Can Be Secondary to Annular Dilatation

Quantification of Mitral Valve Morphology With Three-Dimensional Echocardiography

Floppy Mitral Valve (FMV)/Mitral Valve Prolapse (MVP) and the FMV/MVP Syndrome: Pathophysiologic Mechanisms and Pathogenesis of Symptoms

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