Mitral Valve Leaflet Remodeling After Myocardial Infarction

Watanabe, Nozomi

doi:10.1161/circimaging.117.007114

Cited by 3 publications

(2 citation statements)

References 25 publications

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“…One possible mechanism explaining the discrepancy in the degree of MV prolapse and the degree of MR is mitral valve leaflet remodeling such as stretching, growing in area or increasing in thickness. Remodeling of mitral valve leaflets has been recently recognized as valve adaptation by increasing the area as a biological response to the dilated left ventricle, which has been considered to be a beneficial change in order to keep effective coaptation of the mitral valve . Mitral valve leaflet adaptation has been observed and reported in dilated cardiomyopathy, chronic aortic regurgitation, and myocardial infarction patients .…”

Section: Discussionmentioning

confidence: 99%

“…as valve adaptation by increasing the area as a biological response to the dilated left ventricle, 11 which has been considered to be a beneficial change in order to keep effective coaptation of the mitral valve. 12 Mitral valve leaflet adaptation has been observed and reported in dilated cardiomyopathy, chronic aortic regurgitation, and myocardial infarction patients.…”

Section: Remodeling Of Mitral Valve Leaflets Has Been Recently Recognmentioning

confidence: 99%

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Unique mechanism of mitral valve prolapse in atrial septal defect: Three‐dimensional insights into mitral complex geometry using real‐time transesophageal echocardiography

et al. 2020

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Background Mitral valve prolapse (MVP) is often identified in patients with atrial septal defect (ASD), which occasionally require surgical intervention at the time of ASD closure or even long after the surgery. Ventricular and valvular geometric characteristics in preoperative ASD patients were evaluated by three‐dimensional (3D) transesophageal echocardiography. Methods and Results Mitral valve (MV) complex geometry was quantitatively measured by 3D transesophageal echocardiography in 11 ASD patients (Qp/Qs > 1.5) and 11 controls. The ASD group had a significantly larger indexed prolapse volume and height, with a larger anterior mitral leaflet than controls (0.53 [0.33–0.75] vs 0.057 [0.027–0.11] mL/m2, P = .0001; 2.89 [2.13–3.50] vs 0.92 [0.48–1.32] mm/m2, P < .0001; 391.3 [346.4–445.1] vs 295.3 (281.9–330.0) mm2/m2, P = .011, respectively). The right ventricular (RV)‐to‐left ventricular (LV) end‐systolic diameter ratio was larger in the ASD group than in the control group (1.34 [0.96–1.45] vs 0.85 [0.75–0.88], P = .004). The indexed inter‐papillary muscle distance (IPMD) was significantly shorter in the ASD group than in the control group (7.77 [6.55–8.24] vs 9.71 [8.64–10.8] mm/m2, P = .011). IPMD was significantly correlated with the RV‐LV end‐systolic diameter ratio (r = −.70, P = .017). Conclusions Inward shift of the LV papillary muscle tips due to RV dilation may be a major mechanism of MV prolapse in ASD. At the same time, positive remodeling of the anterior leaflet was observed in the ASD group, which may compensate for the billowing leaflet geometry to maintain effective coaptation. Three‐dimensional assessment of the MV apparatus geometry will help to further understand perioperative mitral regurgitation in patients with ASD.

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Section: Discussionmentioning

confidence: 99%

Section: Remodeling Of Mitral Valve Leaflets Has Been Recently Recognmentioning

confidence: 99%

Unique mechanism of mitral valve prolapse in atrial septal defect: Three‐dimensional insights into mitral complex geometry using real‐time transesophageal echocardiography

et al. 2020

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Impact of Kidney Disease on Catheter-Based Mitral Valve Interventions

Koshkelashvili

Condado

Babaliaros

2020

Kidney Disease in the Cardiac Catheterization Laboratory

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Longitudinal Evaluation of Mitral Valve Leaflet Remodeling After Acute Myocardial Infarction

Nishino

Watanabe

et al. 2020

Circ: Cardiovascular Imaging

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Background: Recent animal studies have suggested that mitral valve (MV) leaflet remodeling can occur even without significant tethering force and that the postinfarct biological reaction would contribute to the histopathologic changes of the leaflet. We serially evaluated the MV remodeling in patients with anterior and inferior acute myocardial infarction (MI), by using 2- and 3-dimensional transthoracic echocardiography. Additional histopathologic examinations were performed to assess the leaflet pathology. Methods: Sixty consecutive first-onset acute MI (anterior MI, n=30; inferior MI, n=30) patients who underwent successful primary percutaneous coronary intervention were examined (1) before primary percutaneous coronary intervention, (2) at 6-month follow-up, and (3) at follow-up 1 year or later after onset. MV complex geometry including MV leaflet area and thickness was analyzed using dedicated software. Additional histopathologic study compared 18 valves harvested during surgery for ischemic mitral regurgitation (MR). Results: MV area and thickness incrementally increased during the follow-up period. MV leaflet area significantly increased (anterior MI: 5.59 [5.28–5.98] to 6.54 [6.20–7.26] cm 2 /m 2 , P <0.001; inferior MI: 5.60 [4.76–6.08] to 6.32 [5.90–6.90] cm 2 /m 2 , P <0.001), and leaflet thickness also increased (anterior MI: 1.09 [0.92–1.24] to 1.45 [1.28–1.60] mm/m 2 , P <0.001; inferior MI: 1.15 [1.03–1.25] to 1.44 [1.27–1.59] mm/m 2 , P <0.001); data represent onset versus ≥1 year. Larger annuls, larger tenting, and a reduced leaflet area/annular ratio with smaller coaptation index were observed in patients with persistent ischemic MR compared with those without significant ischemic MR. Histopathologic examinations revealed that MV thickness was significantly greater in chronic ischemic MR compared with acute ischemic MR (1432.6±490.5 versus 628.7±278.7 μm; P =0.001), with increased smooth muscle cells and fibrotic materials. Conclusions: MV leaflet remodeling progressed both in area and thickness after MI. This is the first clinical study to record the longitudinal course of MV leaflet remodeling by serial echocardiography.

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Mitral Valve Leaflet Remodeling After Myocardial Infarction

Cited by 3 publications

References 25 publications

Unique mechanism of mitral valve prolapse in atrial septal defect: Three‐dimensional insights into mitral complex geometry using real‐time transesophageal echocardiography

Unique mechanism of mitral valve prolapse in atrial septal defect: Three‐dimensional insights into mitral complex geometry using real‐time transesophageal echocardiography

Impact of Kidney Disease on Catheter-Based Mitral Valve Interventions

Longitudinal Evaluation of Mitral Valve Leaflet Remodeling After Acute Myocardial Infarction

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