Left Ventricular Abnormalities in Prolapsed Mitral Leaflet Syndrome

Scampardonis, Gregory; Yang, Sheng‐An; Maranhão, Vladir; Goldberg, Harry; Gooch, Alden S.

doi:10.1161/01.cir.48.2.287

Cited by 154 publications

(41 citation statements)

References 25 publications

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“…1 This study confirmed these studies with echocardiographic images, and further demonstrated a significant correlation between reduced basal LV contraction and basal LV and MV annular dilatation. Basal predominance of LV reduced contraction altered after surgical MV plasty with basal LV and MV annular size reduction, which further supports the correlation, has not been previously reported.…”

Section: Correlation With Previous Investigationssupporting

confidence: 82%

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 Investigationssupporting

confidence: 82%

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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“…3' 4, 7, 10 Upon reviewing the numerous underlying conditions producing the mitral valve deformity, it becomes readily apparent that this entity cannot be encompassed in a single homogeneous group. The various associated conditions include Marfan's syndrome, 1 13 described similar findings in a number of their patients. In addition, they noted that 27 of their 87 patients had asynergistic contractions or relaxations of the left ventricle producing a convex bulge of its anterolateral wall in end systole or early diastole.…”

mentioning

confidence: 76%

“…An earlier onset of the murmur was noted in two patients ( fig. 7) by the presence of an abnormal exercise factor, i.e., 600 ml /min less than 100 ml V02/min In one patient (AM) an exercise cardiac index was not determined because the patient ex 13.2% for the long axis (P < 0.001) and 41.4 (P < 0.005), 41.6 (P < 0.001) and 49.2% (P < 0.005) for the proximal, midventricular and apical diameters, respectively. The data suggest that there is genieralized hypokinesis or impaired contractility of the left ventricle but that it is most marked in the midventricular segment.…”

mentioning

confidence: 99%

The Syndrome of Systolic Click, Murmur, and Mitral Valve Prolapse-A Cardiomyopathy?

et al. 1974

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SUMMARYTwenty six patients with systolic clicks, murmurs, and prolapsed mitral valve leaflets were studied because of distressing chest pain or troublesome arrhythmias. Cardiac catheterization revealed normal coronary arteries and a high incidence of left ventricular (LV) dysfunction.The Left ventriculography revealed mitral valve prolapse in all patients, mitral regurgitation in 20, and mild to severe LV hypertrophy in 14 patients. Contractility, determined angiographically, was markedly impaired in 13 patients with marked hypokinesis of the antero-lateral wall of the LV resulting in the appearance of an unusual prominent convexity in this portion of the ventricle in end systole and early diastole. Seven others had similar but less severe impairment of LV contractility.These results indicate that LV dysfunction, possibly related to a primary myocardial disorder, is a significant component of the syndrome of prolapsed mitral valve leaflet. The findings in the symptomatic patients described in this study cannot be generalized to all patients with this syndrome as our sample excluded patients with mild asymptomatic forms of the disease.

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“…[47][48][49][50][51] The hypothesis that the so-called MVP syndrome is a cardiomyopathy in which regional hypercontractility acts as the primum movens of mitral valve geometry disruption with abnormal tension on the chordae and leaflets and a secondary increase in myxomatous tissue and leaflet thickening has been even advanced. 50,51 Our pathology and CE-CMR data support the theory that LV abnormalities are instead the consequence of MVP owing to a systolic mechanical stretch of the myocardium closely linked to the valve, that is, PMs and inferobasal wall, by the prolapsing leaflets and elongated chordae, accounting for a localized hypercontractility, with myocyte hypertrophy and injury eventually leading to fibrous tissue repair.…”

Section: 43mentioning

confidence: 99%

Arrhythmic Mitral Valve Prolapse and Sudden Cardiac Death

et al. 2015

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Background— Mitral valve prolapse (MVP) may present with ventricular arrhythmias and sudden cardiac death (SCD) even in the absence of hemodynamic impairment. The structural basis of ventricular electric instability remains elusive. Methods and Results— The cardiac pathology registry of 650 young adults (≤40 years of age) with SCD was reviewed, and cases with MVP as the only cause of SCD were re-examined. Forty-three patients with MVP (26 females; age range, 19–40 years; median, 32 years) were identified (7% of all SCD, 13% of women). Among 12 cases with available ECG, 10 (83%) had inverted T waves on inferior leads, and all had right bundle-branch block ventricular arrhythmias. A bileaflet involvement was found in 70%. Left ventricular fibrosis was detected at histology at the level of papillary muscles in all patients, and inferobasal wall in 88%. Living patients with MVP with (n=30) and without (control subjects; n=14) complex ventricular arrhythmias underwent a study protocol including contrast-enhanced cardiac magnetic resonance. Patients with either right bundle-branch block type or polymorphic complex ventricular arrhythmias (22 females; age range, 28–43 years; median, 41 years), showed a bileaflet involvement in 70% of cases. Left ventricular late enhancement was identified by contrast-enhanced cardiac magnetic resonance in 93% of patients versus 14% of control subjects ( P <0.001), with a regional distribution overlapping the histopathology findings in SCD cases. Conclusions— MVP is an underestimated cause of arrhythmic SCD, mostly in young adult women. Fibrosis of the papillary muscles and inferobasal left ventricular wall, suggesting a myocardial stretch by the prolapsing leaflet, is the structural hallmark and correlates with ventricular arrhythmias origin. Contrast-enhanced cardiac magnetic resonance may help to identify in vivo this concealed substrate for risk stratification.

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Left Ventricular Abnormalities in Prolapsed Mitral Leaflet Syndrome

Cited by 154 publications

References 25 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

The Syndrome of Systolic Click, Murmur, and Mitral Valve Prolapse-A Cardiomyopathy?

Arrhythmic Mitral Valve Prolapse and Sudden Cardiac Death

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