3
|
Perazzolo Marra M, Basso C, De Lazzari M, Rizzo S, Cipriani A, Giorgi B, Lacognata C, Rigato I, Migliore F, Pilichou K, Cacciavillani L, Bertaglia E, Frigo AC, Bauce B, Corrado D, Thiene G, Iliceto S. Morphofunctional Abnormalities of Mitral Annulus and Arrhythmic Mitral Valve Prolapse. Circ Cardiovasc Imaging 2017; 9:e005030. [PMID: 27516479 PMCID: PMC4991345 DOI: 10.1161/circimaging.116.005030] [Citation(s) in RCA: 212] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 06/24/2016] [Indexed: 12/22/2022]
Abstract
Supplemental Digital Content is available in the text. Background— Arrhythmic mitral valve prolapse (MVP) is characterized by myxomatous leaflets and left ventricular (LV) fibrosis of papillary muscles and inferobasal wall. We searched for morphofunctional abnormalities of the mitral valve that could explain a regional mechanical myocardial stretch. Methods and Results— Thirty-six (27 female patients; median age: 44 years) arrhythmic MVP patients with LV late gadolinium enhancement on cardiac magnetic resonance and no or trivial mitral regurgitation, and 16 (6 female patients; median age: 40 years) MVP patients without LV late gadolinium enhancement were investigated by morphofunctional cardiac magnetic resonance. Mitral annulus disjunction (median: 4.8 versus 1.8 mm; P<0.001), end-systolic mitral annular diameters (median: 41.2 versus 31.5; P=0.004) and end-diastolic mitral annular diameters (median: 35.5 versus 31.5; P=0.042), prevalence of posterior systolic curling (34 [94%] versus 3 [19%]; P<0.001), and basal to mid LV wall thickness ratio >1.5 (22 [61%] versus 4 [25%]; P=0.016) were higher in MVP patients with late gadolinium enhancement than in those without. A linear correlation was found between mitral annulus disjunction and curling (R=0.85). A higher prevalence of auscultatory midsystolic click (26 [72%] versus 6 [38%]; P=0.018) was also noted. Histology of the mitral annulus showed a longer mitral annulus disjunction in 50 sudden death patients with MVP and LV fibrosis than in 20 patients without MVP (median: 3 versus 1.5 mm; P<0.001). Conclusions— Mitral annulus disjunction is a constant feature of arrhythmic MVP with LV fibrosis. The excessive mobility of the leaflets caused by posterior systolic curling accounts for a mechanical stretch of the inferobasal wall and papillary muscles, eventually leading to myocardial hypertrophy and scarring. These mitral annulus abnormalities, together with auscultatory midsystolic click, may identify MVP patients who would need arrhythmic risk stratification.
Collapse
Affiliation(s)
- Martina Perazzolo Marra
- From the Department of Cardiac, Thoracic, and Vascular Sciences (M.P.M., C.B., M.D.L., S.R., A.C., I.R., F.M., K.P., L.C., E.B., A.C.F., B.B., D.C., G.T., S.I.), Department of Medicine (B.G.), and Department of Radiology (C.L.), Azienda Ospedaliera-University of Padua Medical School, Italy.
| | - Cristina Basso
- From the Department of Cardiac, Thoracic, and Vascular Sciences (M.P.M., C.B., M.D.L., S.R., A.C., I.R., F.M., K.P., L.C., E.B., A.C.F., B.B., D.C., G.T., S.I.), Department of Medicine (B.G.), and Department of Radiology (C.L.), Azienda Ospedaliera-University of Padua Medical School, Italy
| | - Manuel De Lazzari
- From the Department of Cardiac, Thoracic, and Vascular Sciences (M.P.M., C.B., M.D.L., S.R., A.C., I.R., F.M., K.P., L.C., E.B., A.C.F., B.B., D.C., G.T., S.I.), Department of Medicine (B.G.), and Department of Radiology (C.L.), Azienda Ospedaliera-University of Padua Medical School, Italy
| | - Stefania Rizzo
- From the Department of Cardiac, Thoracic, and Vascular Sciences (M.P.M., C.B., M.D.L., S.R., A.C., I.R., F.M., K.P., L.C., E.B., A.C.F., B.B., D.C., G.T., S.I.), Department of Medicine (B.G.), and Department of Radiology (C.L.), Azienda Ospedaliera-University of Padua Medical School, Italy
| | - Alberto Cipriani
- From the Department of Cardiac, Thoracic, and Vascular Sciences (M.P.M., C.B., M.D.L., S.R., A.C., I.R., F.M., K.P., L.C., E.B., A.C.F., B.B., D.C., G.T., S.I.), Department of Medicine (B.G.), and Department of Radiology (C.L.), Azienda Ospedaliera-University of Padua Medical School, Italy
| | - Benedetta Giorgi
- From the Department of Cardiac, Thoracic, and Vascular Sciences (M.P.M., C.B., M.D.L., S.R., A.C., I.R., F.M., K.P., L.C., E.B., A.C.F., B.B., D.C., G.T., S.I.), Department of Medicine (B.G.), and Department of Radiology (C.L.), Azienda Ospedaliera-University of Padua Medical School, Italy
| | - Carmelo Lacognata
- From the Department of Cardiac, Thoracic, and Vascular Sciences (M.P.M., C.B., M.D.L., S.R., A.C., I.R., F.M., K.P., L.C., E.B., A.C.F., B.B., D.C., G.T., S.I.), Department of Medicine (B.G.), and Department of Radiology (C.L.), Azienda Ospedaliera-University of Padua Medical School, Italy
| | - Ilaria Rigato
- From the Department of Cardiac, Thoracic, and Vascular Sciences (M.P.M., C.B., M.D.L., S.R., A.C., I.R., F.M., K.P., L.C., E.B., A.C.F., B.B., D.C., G.T., S.I.), Department of Medicine (B.G.), and Department of Radiology (C.L.), Azienda Ospedaliera-University of Padua Medical School, Italy
| | - Federico Migliore
- From the Department of Cardiac, Thoracic, and Vascular Sciences (M.P.M., C.B., M.D.L., S.R., A.C., I.R., F.M., K.P., L.C., E.B., A.C.F., B.B., D.C., G.T., S.I.), Department of Medicine (B.G.), and Department of Radiology (C.L.), Azienda Ospedaliera-University of Padua Medical School, Italy
| | - Kalliopi Pilichou
- From the Department of Cardiac, Thoracic, and Vascular Sciences (M.P.M., C.B., M.D.L., S.R., A.C., I.R., F.M., K.P., L.C., E.B., A.C.F., B.B., D.C., G.T., S.I.), Department of Medicine (B.G.), and Department of Radiology (C.L.), Azienda Ospedaliera-University of Padua Medical School, Italy
| | - Luisa Cacciavillani
- From the Department of Cardiac, Thoracic, and Vascular Sciences (M.P.M., C.B., M.D.L., S.R., A.C., I.R., F.M., K.P., L.C., E.B., A.C.F., B.B., D.C., G.T., S.I.), Department of Medicine (B.G.), and Department of Radiology (C.L.), Azienda Ospedaliera-University of Padua Medical School, Italy
| | - Emanuele Bertaglia
- From the Department of Cardiac, Thoracic, and Vascular Sciences (M.P.M., C.B., M.D.L., S.R., A.C., I.R., F.M., K.P., L.C., E.B., A.C.F., B.B., D.C., G.T., S.I.), Department of Medicine (B.G.), and Department of Radiology (C.L.), Azienda Ospedaliera-University of Padua Medical School, Italy
| | - Anna Chiara Frigo
- From the Department of Cardiac, Thoracic, and Vascular Sciences (M.P.M., C.B., M.D.L., S.R., A.C., I.R., F.M., K.P., L.C., E.B., A.C.F., B.B., D.C., G.T., S.I.), Department of Medicine (B.G.), and Department of Radiology (C.L.), Azienda Ospedaliera-University of Padua Medical School, Italy
| | - Barbara Bauce
- From the Department of Cardiac, Thoracic, and Vascular Sciences (M.P.M., C.B., M.D.L., S.R., A.C., I.R., F.M., K.P., L.C., E.B., A.C.F., B.B., D.C., G.T., S.I.), Department of Medicine (B.G.), and Department of Radiology (C.L.), Azienda Ospedaliera-University of Padua Medical School, Italy
| | - Domenico Corrado
- From the Department of Cardiac, Thoracic, and Vascular Sciences (M.P.M., C.B., M.D.L., S.R., A.C., I.R., F.M., K.P., L.C., E.B., A.C.F., B.B., D.C., G.T., S.I.), Department of Medicine (B.G.), and Department of Radiology (C.L.), Azienda Ospedaliera-University of Padua Medical School, Italy
| | - Gaetano Thiene
- From the Department of Cardiac, Thoracic, and Vascular Sciences (M.P.M., C.B., M.D.L., S.R., A.C., I.R., F.M., K.P., L.C., E.B., A.C.F., B.B., D.C., G.T., S.I.), Department of Medicine (B.G.), and Department of Radiology (C.L.), Azienda Ospedaliera-University of Padua Medical School, Italy
| | - Sabino Iliceto
- From the Department of Cardiac, Thoracic, and Vascular Sciences (M.P.M., C.B., M.D.L., S.R., A.C., I.R., F.M., K.P., L.C., E.B., A.C.F., B.B., D.C., G.T., S.I.), Department of Medicine (B.G.), and Department of Radiology (C.L.), Azienda Ospedaliera-University of Padua Medical School, Italy
| |
Collapse
|