Abstract 12500: Attenuated Basal Left Ventricular Wall Contraction in Patients With Mitral Valve Prolapse Can be Secondary to Annular Dilatation With Augmented Closing Force: Pre- and Post-Operative Speckle Tracking Echocardiographic Study

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Shota Fukuda ◽  
Jae-Kwan Song ◽  
Hiroshi Kuwaki ◽  
Jeong-Yoon Jang ◽  
Masaaki Takeuchi ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Mitral Valve Prolapse ◽  
Speckle Tracking ◽  
Mitral Annulus ◽  
Strain Ratio ◽  
Left Ventricular ◽  
Size Reduction ◽  
Closing Force ◽  
Wall Contraction

Introduction: Mitral annulus (MA) is generally enlarged in patients with mitral valve prolapse (MVP), which may raise MV closing force acting to shift the MV and its adjacent basal left ventricular (LV) wall toward left atrium. Hypothesis: MA dilatation with augmented MV closing force may disturb basal LV wall systolic contraction in patients with MVP. Methods: In 11 healthy controls and 34 patients with MVP, 3 apical views were obtained to assess longitudinal strain of basal- and mid-LV segments by speckle tracking analysis. The ratio of basal- to mid-LV strain value was then calculated. MA area was calculated by annulus diameters in apical 4- and 2- chamber views. MV closing force was calculated as MA area х (systolic blood pressure - 10). Results: Patients with MVP showed significantly larger MA area (5.3±1.0 vs 3.8±0.7 cm2/m2) and MV closing force (638±192 vs 431±66 mmHg•cm2/m2), and reduced basal-LV strain (-18±3 vs -21±2%) than controls (all p<0.005), whereas mid-LV strain was similar between the 2 groups (-22±4 vs -22±3%, p=0.4). Consequently, significantly lower basal/middle ratio was observed in patients with MVP compared to controls (0.86±0.11 vs 0.95±0.08, p=0.004). By multivariate analysis, reduced basal/middle strain ratio was associated with augmented MV closing force (β=0.45, p=0.005) (Figure A), independent from the severity of mitral regurgitation (p=0.7). The basal/middle strain ratio significantly increased to 1.07±0.10 after annular size reduction in 5 patients with surgical MV plasty (p=0.04) (Figures B and C). Conclusions: In patients with MVP, an increase in MV closing force corresponding to MA dilatation, as opposed to the severity of mitral regurgitation, was related to attenuated basal LV wall contraction, which can be restored by MV plasty with annular size reduction.

scholarly journals Replacement Myocardial Fibrosis in Patients with Mitral Valve Prolapse: Relation to Mitral Regurgitation, Ventricular Remodeling and Arrhythmia

Circulation ◽  
2021 ◽  
Author(s):  
Anne-Laure Constant Dit Beaufils ◽  
Olivier Huttin ◽  
Antoine Jobbe-Duval ◽  
Thomas Senage ◽  
Laura Filippetti ◽  
...  
Keyword(s):  
Heart Failure ◽  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Ventricular Arrhythmia ◽  
Myocardial Fibrosis ◽  
Mitral Valve Prolapse ◽  
Cardiovascular Events ◽  
Prognostic Significance ◽  
Left Ventricular ◽  
Arterial Embolism

Background: Mitral valve prolapse (MVP) is a frequent disease that can be complicated by mitral regurgitation (MR), heart failure, arterial embolism, rhythm disorders and death. Left ventricular (LV) replacement myocardial fibrosis, a marker of maladaptive remodeling, has been described in patients with MVP, but the implications of this finding remain scarcely explored. We aimed at assessing the prevalence, pathophysiological and prognostic significance of LV replacement myocardial fibrosis through late gadolinium enhancement (LGE) by cardiac magnetic resonance (CMR) in patients with MVP. Methods: Four hundred patients (53±15 years, 55% male) with MVP (trace to severe MR by echocardiography) from 2 centers, who underwent a comprehensive echocardiography and LGE CMR, were included. Correlates of replacement myocardial fibrosis (LGE+), influence of MR degree, and ventricular arrhythmia were assessed. The primary outcome was a composite of cardiovascular events (cardiac death, heart failure, new-onset atrial fibrillation, arterial embolism, and life-threatening ventricular arrhythmia). Results: Replacement myocardial fibrosis (LGE+) was observed in 110 patients (28%; 91 myocardial wall including 71 basal inferolateral wall, 29 papillary muscle). LGE+ prevalence was 13% in trace-mild MR, 28% in moderate and 37% in severe MR, and was associated with specific features of mitral valve apparatus, more dilated LV and more frequent ventricular arrhythmias (45 vs 26%, P<0.0001). In trace-mild MR, despite the absence of significant volume overload, abnormal LV dilatation was observed in 16% of patients and ventricular arrhythmia in 25%. Correlates of LGE+ in multivariable analysis were LV mass (OR 1.01, 95% CI [1.002-1.017], P=0.009) and moderate-severe MR (OR: 2.28, 95% CI [1.21-4.31], P=0.011). LGE+ was associated with worse 4-year cardiovascular event-free survival (49.6±11.7 in LGE+ vs 73.3±6.5% in LGE-, P<0.0001). In a stepwise multivariable Cox model, MR volume and LGE+ (HR: 2.6 [1.4-4.9], P=0.002) were associated with poor outcome. Conclusions: LV replacement myocardial fibrosis is frequent in patients with MVP, is associated with mitral valve apparatus alteration, more dilated LV, MR grade, ventricular arrhythmia, and is independently associated with cardiovascular events. These findings suggest a MVP-related myocardial disease. Finally, CMR provides additional information to echocardiography in MVP.

Effect of Progressive Left Ventricular Dilatation on Degree of Mitral Regurgitation Secondary to Mitral Valve Prolapse

2019 ◽  
Vol 123 (11) ◽  
pp. 1887-1888
Author(s):  
William C. Roberts ◽  
Paul A. Grayburn ◽  
Stuart R. Lander ◽  
Dan M. Meyer ◽  
Shelley A. Hall
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Mitral Valve Prolapse ◽  
Left Ventricular ◽  
Ventricular Dilatation ◽  
Left Ventricular Dilatation

Excessive Papillary Muscle Traction and Dilated Mitral Annulus in Mitral Valve Prolapse Without Mitral Regurgitation

1996 ◽  
Vol 78 (4) ◽  
pp. 482-485 ◽  
Author(s):  
Tsung-Ming Lee ◽  
Sheng-Fang Su ◽  
Tsuei-Yuen Huang ◽  
Ming-Fong Chen ◽  
Chiau-Suong Liau ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Papillary Muscle ◽  
Mitral Valve Prolapse ◽  
Mitral Annulus

Impact of Preoperative Left Atrial Dimension on Outcome in Patients in Sinus Rhythm Undergoing Surgical Valve Repair for Severe Mitral Regurgitation due to Mitral Valve Prolapse

Cardiology ◽  
2019 ◽  
Vol 142 (3) ◽  
pp. 189-193
Author(s):  
Catherine Szymanski ◽  
Yohann Bohbot ◽  
Dan Rusinaru ◽  
Gilles Touati ◽  
Christophe Tribouilloy
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Sinus Rhythm ◽  
Mitral Valve Prolapse ◽  
Left Atrial ◽  
Reference Group ◽  
Left Ventricular ◽  
Valve Repair ◽  
And Function

Background: Left atrial (LA) enlargement has been previously identified as a predictor of mortality in patients with medically managed mitral regurgitation (MR) due to mitral valve prolapse (MVP). No study has specifically assessed the prognostic value of LA size in patients undergoing mitral valve repair (MVRp). Objective: We aimed to investigate the relationship between LA area and mortality in patients in sinus rhythm (SR) undergoing MVRp for MVP. Methods: We included 305 patients in SR who underwent MVRp for MVP. Median follow-up time was 7.9 years. Patients were divided into 3 groups: LA area ≤25 cm2 (reference group), LA 26–30 cm2, and LA >30 cm2. Results: Compared with patients with an LA area ≤25 cm2, those with an LA area >30 cm2 had a lower 10-year survival (98 ± 2 vs. 86 ± 4%; p = 0.037). In multivariate analysis, after adjustment for established outcome predictors including age, symptoms, EuroSCORE, and left ventricular size and function, LA enlargement >30 cm2 was associated with increased mortality (adjusted HR = 2.20, 95% CI 1.03–4.90; p = 0.042), whereas LA enlargement between 26 and 30 cm2 was not (adjusted HR = 1.37, 95% CI 0.56–3.56; p = 0.52). Conclusion: LA enlargement is independently predictive of long-term mortality after MVRp in patients in SR with severe MR due to MVP. Our findings suggest that MVRp should be considered before the LA area exceeds 30 cm2.

Left Ventricular Torsion By Speckle Tracking: A Study On Master Athletes With Mitral Valve Prolapse

2011 ◽  
Vol 43 (Suppl 1) ◽  
pp. 917-918
Author(s):  
Loira Toncelli ◽  
Alessio De Luca ◽  
Francesco Cappelli ◽  
Brunello Cappelli ◽  
Robertina M. C. Vono ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Valve Prolapse ◽  
Speckle Tracking ◽  
Left Ventricular ◽  
Master Athletes ◽  
Left Ventricular Torsion ◽  
Ventricular Torsion

P6491Predictive effect of mitral annular size on persistent mitral valve dysfunction after transcatheter edge-to-edge mitral valve repair for functional mitral regurgitation

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Kitamura ◽  
T Schmidt ◽  
D Schewel ◽  
H Alessandrini ◽  
K.-H Kuck ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Mitral Annulus ◽  
Left Ventricular ◽  
The Other ◽  
Left Ventricular Ejection ◽  
Functional Mitral Regurgitation ◽  
Ventricular Ejection Fraction ◽  
The Mean ◽  
Predictive Effect

Abstract Background In patients with functional mitral regurgitation (FMR), deformation of the mitral valve (MV) apparatus leads to deteriorating coaptation of both leaflets. The MV geometry is essential to predict procedural success of using the MitraClip™ for FMR patients. Persistent such mitral regurgitation (MR) and post-procedural mitral stenosis (MS) are parameters for an increasing mortality rate after MitraClip implantation. The anterior-to-posterior mitral annulus diameter (MAD) is simple to evaluate with a high reproducibility rate. However, the predictive effect has not been determined to date. Purpose We evaluated the predictive effect of baseline anterior-to-posterior MAD on persistent MV dysfunctions after MitraClip™ implantation. Methods We investigated the prevalence of procedural failure (MR at discharge > grade 2+) and post-procedural MS (mean transmitral gradient (mTMG) at discharge ≥6 mmHg) in a patient cohort with FMR (n=190), who underwent MitraClip™ implantation. We measured the MV apparatus geometry on mid-systole using transoesophageal echocardiography before the index procedure. The MAD was stratified by interquartile ranges (IQR) in the comparison. (≤34 mm, 35 to 37 mm, 38 to 40 mm, and ≥41 mm, respectively) Results The mean age was 75±9 years, and 63 patients (33%) were female. The mean left ventricular ejection fraction was 34±14%. Moderate-to-severe (3+) or severe MR (4+) were documented in all patients before the procedure. Transthoracic echocardiography at discharge revealed residual MR (>2+) in 10 patients (5%) and post-procedural MS in 13 patients (7%), in which one patient presented with both residual MR and MS. After stratification by the IQRs of MAD, there were significant differences in body weight (p<0.001), height (p<0.001), and body surface area (p<0.001), but no significant differences in the other baseline characteristics. Notably, significant differences in the prevalence of procedural failure (p=0.004) and post-procedural MS (p=0.022) were observed among the groups. (Figure) Specifically, in the cohort with the 4th IQR (MAD ≥41 mm, n=44), procedural failure was observed in 7 patients (16%), although the prevalence was only 2% in the other IQR groups. Moreover, the cohorts with the 1st and 2nd IQR presented with higher prevalence of post-procedural MS (6 of 46 patients (13%) in the 1st IQR group, and 6 of 51 (12%) in the 2nd IQR group) than those with the 3rd and 4th IQRs. (1 of 49 patients (2%) in the 3rd IQR, and none of 44 patients in the 4th IQR) Figure 1 Conclusion In this analysis we showed that the mitral annulus size affected MV dysfunction after MitraClip™. Anterior-to-posterior MAD was useful to predict the procedural result. For FMR candidates with dilated mitral annulus larger than 40 mm, new-generation MitraClip-XTR™ system or other therapeutic concept such as annuloplasty may be reasonable to obtain satisfactory MV function.

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