Three-Dimensional Transthoracic Static and Dynamic Normative Values of the Mitral Valve Apparatus: Results from the Multicenter World Alliance Societies of Echocardiography Study

Henry, Michael P.; Cotella, Juan I; Mor‐Avi, Victor; Addetia, Karima; Miyoshi, Tatsuya; Schreckenberg, Marcus; Blankenhagen, Michael; Hitschrich, Niklas; Amuthan, Vivekanandan; Citro, Rodolfo; Daimon, Masao; Gutiérrez-Fajardo, Pedro; Kasliwal, Ravi R; Kirkpatrick, James N.; Monaghan, Mark; Muraru, Denisa; Ogunyankin, Kofo O.; Park, Seung Woo; Rodrigues, Ana Clara Tude; Ronderos, Ricardo; Sadeghpour, Anita; Scalia, G.; Takeuchi, Masaaki; Tsang, Wendy; Tucay, Edwin S.; Zhang, Mei; Lang, Roberto M.; Asch, Federico M.

doi:10.1016/j.echo.2022.02.010

Cited by 16 publications

(5 citation statements)

References 46 publications

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“…Elongation of the AML and PML (as compared to normal reference range [11]) was observed in most patients in this study, in-line with previous studies of patients HOCM suggesting elongated MV leaflets as being part of the innate HCM phenotype [11,16–18]. Although the correlation between MVLL and outcome after ASA has not yet been shown.…”

Section: Discussionsupporting

confidence: 89%

Alcohol septal ablation in hypertrophic obstructive cardiomyopathy: do sex, mitral valve leaflet length and septal thickness affect the outcome?

Mustafic,

Jandér,

Marlevi

et al. 2024

Preprint

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PurposeThis retrospective cohort study aimed to assess whether basal septal wall thickness (BSWT), anterior (AML) and posterior (PML) mitral leaflet length, or sex were associated with remaining left ventricular outflow tract obstruction (LVOTO) in patients with hypertrophic obstructive cardiomyopathy (HOCM) undergoing alcohol septal ablation (ASA).Methods154 patients that underwent ASA at the Karolinska University Hospital in Stockholm, Sweden, between 2009 and 2021, were retrospectively included. Anatomical and hemodynamic parameters were collected from invasive catheterization before and during ASA, and from echocardiography (ECHO) examinations before, during, and at one-year follow-up after ASA. Linear and logistic regression models were used to assess the association between sex, BSWT, AML, PML, and outcome defined as remaining LVOTO (>30 mmHg) after ASA.ResultsThe median follow-up was 364 days (IQR 334-385 days). BSWT>23 mm (n=13, 12%) was associated with remaining LVOTO at follow-up (p=0.004). Elongated MVLL (either AML or PML) was present in 125 (90%) of the patients. Elongated AML (>24 mm) was present in 67 (44%) of the patients, although AML length was not associated with remaining LVOTO at follow-up. Elongated PML (>14 mm) was present in 114 (74%) and not associated with remaining LVOTO at follow-up. No significant sex differences were observed regarding remaining LVOTO.ConclusionECHO measurement of BSWT can be used effectively for patient selection for successful ASA and for identification of patients with a risk of incomplete resolution of LVOTO after ASA.

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Section: Discussionsupporting

confidence: 89%

Alcohol septal ablation in hypertrophic obstructive cardiomyopathy: do sex, mitral valve leaflet length and septal thickness affect the outcome?

Mustafic,

Jandér,

Marlevi

et al. 2024

Preprint

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“…Recently, the multicenter World Alliance Societies of Echocardiography study used transthoracic 3DE to derive the dynamic normative values of the mitral valve apparatus, discovering that the mitral annular size of Asian populations was significantly smaller than that of White and Black populations 18 . It is reasonable to assume that the same finding will occur in the TA.…”

Section: Discussionmentioning

confidence: 99%

Dynamic assessment of the tricuspid annulus in a healthy Asian population: A four‐dimensional echocardiography study

Huang

et al. 2023

Echocardiography

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Background Tricuspid annulus (TA) geometry and function reference values are limited, especially for Asian populations. We aimed to explore TA using four‐dimensional echocardiography (4DE) in a healthy Asian population. Methods A total of 355 healthy Asian volunteers (median age 34 years; 52% males) were prospectively enrolled. TA geometry and function were analyzed using 4DE throughout the cardiac cycle. Results The TA area, perimeter, and dimensions were smallest at end systole (ES) and largest at late diastole (LD). Normal TA parameters at end diastole (ED) in different sex and age groups were obtained. TA areas, perimeters, and dimensions in males were significantly larger than those in females at ED; BSA‐indexed perimeters and BSA‐indexed dimensions in males were significantly smaller than those in females at ED. TA parameters correlated well with tricuspid valve (TV) tenting, right ventricle (RV), and right atrium (RA) parameters. Conclusions Reference values of TA parameters were obtained by 4DE in an Asian population. Quantitative data on TA geometry and function are essential for TA pathology and therapeutics.

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“…Age and sex differences in normal mitral valve dimensions and anatomy have been reported, although many differences are comparable with and/or smaller than the corresponding measurement variability [7].…”

Section: The Normal Mitral Valvementioning

confidence: 94%

The mitral valve in hypertrophic cardiomyopathy

Malcolmson

Shipolini

Mohiddin

et al. 2023

Current Opinion in Cardiology

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Purpose of review Whilst abnormally increased left ventricular wall thickness is the hallmark feature of hypertrophic cardiomyopathy (HCM), anomalies of the mitral valve and supporting apparatus are well documented. This review addresses the clinical importance of mitral valve abnormalities in HCM, their mechanistic associations with symptoms, and therapeutic strategies targeting mitral valve and apparatus abnormalities. Recent findings The normal mitral valve possesses anatomical features facilitating unrestricted blood flow during LV filling, preventing regurgitation during LV systole, and avoiding obstruction of LV ejection. In HCM, a variety of structural and functional abnormalities can conspire to cause deranged mitral valve function, with implications for management strategy. Identification and characterization of these abnormalities is facilitated by multimodality imaging. Alcohol septal ablation (ASA) cannot address primary mitral valve abnormalities, and so is not preferred to surgical intervention if mitral valve abnormalities are present and are judged to make dominant contributions to LV outflow tract obstruction (LVOTO). Two broadly opposing surgical intervention strategies exist, one advocating isolated septal myectomy and the other including adjuvant mitral apparatus modification. Newer, less invasive surgical and transcatheter techniques will expand interventional options. Summary Mitral valve abnormalities are a central pathological feature of HCM. Multimodality imaging is crucial for their identification and characterization prior to therapeutic intervention.

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Three-Dimensional Transthoracic Static and Dynamic Normative Values of the Mitral Valve Apparatus: Results from the Multicenter World Alliance Societies of Echocardiography Study

Cited by 16 publications

References 46 publications

Alcohol septal ablation in hypertrophic obstructive cardiomyopathy: do sex, mitral valve leaflet length and septal thickness affect the outcome?

Alcohol septal ablation in hypertrophic obstructive cardiomyopathy: do sex, mitral valve leaflet length and septal thickness affect the outcome?

Dynamic assessment of the tricuspid annulus in a healthy Asian population: A four‐dimensional echocardiography study

The mitral valve in hypertrophic cardiomyopathy

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