Relationship between mitral annulus function and mitral regurgitation severity and left atrial remodelling in patients with primary mitral regurgitation

Mihaila, S.; Muraru, Denisa; Miglioranza, Marcelo Haertel; Piasentini, Eleonora; Aruta, Patrizia; Cucchini, Umberto; Iliceto, Sabino; Vinereanu, Dragoş; Badano, Luigi P.

doi:10.1093/ehjci/jev301

Cited by 25 publications

(23 citation statements)

References 29 publications

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“…Prior studies have presented a broad range of normal MA dimensions. 3D echocardiographic studies have reported normal mid-systolic values ranging from 8.2 to 10.5 cm 2 for 3D area, 106 to 128 mm for perimeter, 28 to 32.7 mm for AP diameter, 38.7 to 39 mm for IC diameter, and 6.6 to 7.9 mm for height 11 – 13 . Similar results have been conducted on CT, with one study reporting a mean MA area of 8.9 ± 1.5 cm 2 , perimeter of 110 ± 9 mm, AP diameter of 27.5 ± 2.7 mm and IC diameter of 37.6 ± 3.7 mm 10 .…”

Section: Discussionmentioning

confidence: 99%

“…MA motion serves as an important clinical indicator of regional as well as global LV function 7 . Previous attempts to assess the MA dynamics and geometry include using 2D or 3D echocardiography and computed tomography (CT) 8 – 13 . These approaches suffer from either limited spatial resolution and coverage 8 , 14 , 15 or ionizing radiation 9 .…”

Section: Discussionmentioning

confidence: 99%

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Imaging 4D morphology and dynamics of mitral annulus in humans using cardiac cine MR feature tracking

Leng

Zhang

Jiang

et al. 2018

Sci Rep

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Feature tracking in cine cardiac magnetic resonance (CMR) is a quantitative technique to assess heart structure and function. We investigated 4-dimensional (4D) dynamics and morphology of the mitral annulus (MA) using a novel tracking system based on radially rotational long-axis cine CMR series. A total of 30 normal controls and patients with mitral regurgitation were enrolled. The spatiotemporal changes of the MA were characterized by an in-house developed program. Dynamic and morphological parameters extracted from all 18 radial slices were used as references and were compared with those from subsequently generated sub-datasets with different degrees of sparsity. An excellent agreement was found among all datasets including routine 2-, 3- and 4-chamber views for MA dynamics such as peak systolic velocity (Sm) and mitral annular plane systolic excursion (MAPSE). MA morphology for size and shape was addressed adequately by as few as 6 radial slices, but poorly by only three routine views. Patients with regurgitation showed significantly reduced mitral dynamics and mild annular deformation, which was consistent between three routine views and 18 reference slices. In conclusion, feature tracking cine CMR provided a comprehensive and distinctive profile for 4D MA dynamics and morphology, which may help in studying different cardiac diseases.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Imaging 4D morphology and dynamics of mitral annulus in humans using cardiac cine MR feature tracking

Leng

Zhang

Jiang

et al. 2018

Sci Rep

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“…On the other side, annulus height is close to normal. Annular enlargement is correlated with severity of MR (27,28). Importantly, annular enlargement in patients with MD is different from that of patients with ischemic MR, in which only the anteroposterior annulus is enlarged.…”

Section: Mitral Annulus Dynamicsmentioning

confidence: 99%

Mitral Regurgitation: Anatomy, Physiology, and Pathophysiology—Lessons Learned From Surgery and Cardiac Imaging

Topilsky

2020

Front. Cardiovasc. Med.

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The normal mitral valve is a dynamic structure that permits blood to flow from the left atrial (LA) to left ventricle (LV) during diastole and sealing of the LA from the LV during systole. The main components of the mitral apparatus are the mitral annulus (MA), the mitral leaflets, the chordae tendineae, and the papillary muscles (PM) (Figure 1). Normal valve function is dependent on the integrity and normal interplay of these components. Abnormal function of any one of the components, or their interplay can result in mitral regurgitation (MR). Understanding the anatomy and physiology of all the component of the mitral valve is important for the diagnosis, and for optimal planning of repair procedures. In this review we will focus first on normal anatomy and physiology of the different parts of the mitral valve (MA, leaflets, chordae tendineae, and PM). In the second part we will focus on the pathologic anatomic and physiologic derangements associated with different types of MR.

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“…Inconsistent data on annular measurements in the literature may be related to which anatomic landmarks are assessed. [5][6][7][8][9][10][16][17][18] One example is the distance between the commissures, for which a number of approaches have been reported in the literature: intercommissural width, extended CW, commissure to commissure, maximum transverse diameter, longest diameter, and anterolateralposteromedial diameter. Therefore, estimations of annular area and AHCWR may depend on which anatomic landmarks were included in the measurements.…”

Section: Measuring Mitral Annular Dynamicsmentioning

confidence: 99%

“…Furthermore, different definitions of the NPA most probably explain the wide range of systolic NPA values reported in healthy control subjects (ranging from 127 to 147 ). Different ''nadir points'' are chosen, including the lowest coaptation point, 6,[16][17][18] as was demonstrated by the fact that MPR was associated with less saddle shape or, alternatively at the level of the commissures (3D VSAS), with a higher degree of nonplanarity. Figure 8 illustrates the difference in how these measurements are obtained.…”

Section: Measuring Mitral Annular Dynamicsmentioning

confidence: 99%

Validation of a Holographic Display for Quantification of Mitral Annular Dynamics by Three-Dimensional Echocardiography

Dumont

Kvitting

Karlsen

et al. 2019

Journal of the American Society of Echocardiography

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Background: Three-dimensional (3D) echocardiography with multiplanar reconstruction (MPR) is used clinically to quantify the mitral annulus. MPR images are, however, presented on a two-dimensional screen, calling into question their accuracy. An alternative to MPR is an autostereoscopic holographic display that enables indepth visualization of 3D echocardiographic data without the need for special glasses. The aim of this study was to validate an autostereoscopic display using sonomicrometry as a gold standard. Methods:In 11 anesthetized open-chest pigs, sonomicrometric crystals were placed along the mitral annulus and near the left ventricular apex. High-fidelity catheters measured left atrial and ventricular pressures. Adjustments of pre-and afterload were done by constriction of the inferior vena cava and the ascending aorta, respectively. Three-dimensional epicardial echocardiography was obtained from an apical view and converted to the autostereoscopic display. A 3D virtual semitransparent annular surface (VSAS) was generated to measure commissure width (CW), septal-lateral length, area of the mitral annular surface, nonplanarity angle, and the annular height-to-commissure width ratio in mid-systole and late diastole.Results: Mitral annular measurements from the 3D VSAS derived from the 3D echocardiographic images and autostereoscopic display correlated well with sonomicrometry over a range of loading conditions: CW length (r = 0.98, P < .00001), septal-lateral length (r = 0.98, P < .00001), annular surface area (r = 0.93, P < .001), nonplanarity angle (r = 0.87, P < .001), and annular height-to-commissure width ratio (r = 0.85, P < .01). The 3D VSAS showed better agreement with the sonomicrometric measurements compared with MPR.Conclusions: Mitral annular measurements using 3D VSAS correlate well with sonomicrometry over a range of loading conditions and may represent a powerful tool for noninvasive quantification of mitral annular dynamics. (J Am Soc Echocardiogr 2019;32:303-16.)

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Relationship between mitral annulus function and mitral regurgitation severity and left atrial remodelling in patients with primary mitral regurgitation

Abstract: In patients with OMR, MA reduced function correlates with the MR severity and the LA size and function, but not with the LV function.

Cited by 25 publications

References 29 publications

Imaging 4D morphology and dynamics of mitral annulus in humans using cardiac cine MR feature tracking

Imaging 4D morphology and dynamics of mitral annulus in humans using cardiac cine MR feature tracking

Mitral Regurgitation: Anatomy, Physiology, and Pathophysiology—Lessons Learned From Surgery and Cardiac Imaging

Validation of a Holographic Display for Quantification of Mitral Annular Dynamics by Three-Dimensional Echocardiography

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