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Vriz O, Eltayeb A, Landi I, Anwar K, Alenazy A, Hiristova K, Kasprzak J, D'Andrea A, Amro B, Limongelli G, Bossone E, Imazio M. Transthoracic echocardiography for arrhythmic mitral valve prolapse: Phenotypic characterization as first step. Echocardiography 2022; 39:1158-1170. [PMID: 36029124 DOI: 10.1111/echo.15439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 07/09/2022] [Accepted: 08/09/2022] [Indexed: 11/30/2022] Open
Abstract
Mitral valve prolapse (MVP) is the most frequent valvulopathy with a prevalence of 1.2%-2.4% in general population and it is characterized by a benign course. Although it can be associated with some complications, ventricular arrhythmias (VA) and sudden cardiac death (SCD) as ultimate expressions, are the most worrying. The estimated risk of SCD in MVP is between 0.2% and 1.9% per year including both MVP patients with left ventricular (LV) dysfunction due to severe MR and MVP patients without significant MR. The latter ones constitute a particular phenotype called "malignant MVP" characterized by bileaflet myxomatous prolapse, ECG repolarization abnormalities and complex VAs (c-VAs) with polymorphic/right bundle branch block morphology (RBBB) and LV fibrosis of the papillary muscles (PMs) and inferobasal wall secondary to mechanical stretching visualized as late gadolinium enhancement (LGE) areas by cardiac magnetic resonance (CMR). In MVP, the first diagnostic approach is transthoracic echocardiography (TTE) that defines the presence of mitral annular disjunction (MAD) which seems to be associated with "arrhythmic MVP" (AMVP). From an ECG point of view, AMVP is characterized by frequent premature ventricular contractions (PVCs) arising from one or both PMs, fascicular tissue, and outflow tract, as well as by T-wave inversion in the inferolateral leads. The aim of the present paper is to describe TTE red flags that could identify MVP patients at high risk to develop complex arrhythmias as supported by the corresponding findings of LGE-CMR and anatomy studies. TTE could be a co-partner in phenotyping high-risk arrhythmic MVP patients.
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Affiliation(s)
- Olga Vriz
- Heart Centre, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Abdulla Eltayeb
- Heart Centre, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Irene Landi
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - Kashif Anwar
- Heart Centre, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Ali Alenazy
- Heart Centre, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Krassimira Hiristova
- Department of Noninvasive Diagnostic Imaging, National Heart Hospital, Sofia, Bulgaria
| | - Jarek Kasprzak
- Cardiology, Bieganski Hospital, Medical University, Lodz, Poland
| | - Antonello D'Andrea
- Department of Cardiology, Umberto I Hospital, Luigi Vanvitelli University - Nocera Inferiore (ASL Salerno), Caserta, Italy
| | - Bandar Amro
- Heart Centre, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Giuseppe Limongelli
- Inherited and Rare Cardiovascular Disease Unit, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", AORN dei Colli, Monaldi Hospital, Naples, Italy
| | - Eduardo Bossone
- Azienda Ospedaliera di Rilevanza Nazionale "A. Cardarelli" Hospital, Naples, Italy
| | - Massimo Imazio
- Department of Cardiology, University Hospital Santa Maria della Misericordia, Udine, Italy
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A Quantitative Approach to the Intraoperative Echocardiographic Assessment of the Mitral Valve for Repair. Anesth Analg 2015; 121:34-58. [DOI: 10.1213/ane.0000000000000726] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Hagège AA, Carpentier A, Levine RA. Dynamic changes of the mitral valve annulus: new look at mitral valve diseases. Circ Cardiovasc Imaging 2015; 8:CIRCIMAGING.115.003539. [PMID: 25956923 DOI: 10.1161/circimaging.115.003539] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Albert A Hagège
- From the Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité, Paris, France (A.A.H., A.C., R.A.L.); INSERM U970, Paris Cardiovascular Research Center, Hôpital Européen Georges Pompidou, Paris, France (A.A.H.); Department of Cardiology (A.A.H.) and Department of Cardiovascular Surgery (A.C.), Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France; and Cardiac Ultrasound Laboratory, Massachusetts General Hospital and Harvard Medical School, Boston, MA (R.A.L.).
| | - Alain Carpentier
- From the Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité, Paris, France (A.A.H., A.C., R.A.L.); INSERM U970, Paris Cardiovascular Research Center, Hôpital Européen Georges Pompidou, Paris, France (A.A.H.); Department of Cardiology (A.A.H.) and Department of Cardiovascular Surgery (A.C.), Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France; and Cardiac Ultrasound Laboratory, Massachusetts General Hospital and Harvard Medical School, Boston, MA (R.A.L.)
| | - Robert A Levine
- From the Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité, Paris, France (A.A.H., A.C., R.A.L.); INSERM U970, Paris Cardiovascular Research Center, Hôpital Européen Georges Pompidou, Paris, France (A.A.H.); Department of Cardiology (A.A.H.) and Department of Cardiovascular Surgery (A.C.), Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France; and Cardiac Ultrasound Laboratory, Massachusetts General Hospital and Harvard Medical School, Boston, MA (R.A.L.)
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Shakil O, Jainandunsing JS, Ilic R, Matyal R, Mahmood F. Ischemic Mitral Regurgitation: An Intraoperative Echocardiographic Perspective. J Cardiothorac Vasc Anesth 2013; 27:573-85. [DOI: 10.1053/j.jvca.2012.06.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2012] [Indexed: 11/11/2022]
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Mechanistic Insights into Ischemic Mitral Regurgitation: Echocardiographic and Surgical Implications. J Am Soc Echocardiogr 2011; 24:707-19. [DOI: 10.1016/j.echo.2011.04.001] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2010] [Indexed: 11/24/2022]
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Shudo Y, Matsue H, Toda K, Hata H, Fujita S, Taniguchi K, Sawa Y. A Simplified Echocardiographic Measurements of Direct Effects of Restrictive Annuloplasty on Mitral Valve Geometry. Echocardiography 2010; 27:931-6. [DOI: 10.1111/j.1540-8175.2010.01182.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Effects and mechanisms of left ventricular false tendons on functional mitral regurgitation in patients with severe cardiomyopathy. J Thorac Cardiovasc Surg 2009; 138:1123-8. [DOI: 10.1016/j.jtcvs.2008.10.056] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2008] [Revised: 08/08/2008] [Accepted: 10/03/2008] [Indexed: 11/23/2022]
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PIAZZA NICOLO, BONAN RAOUL. Transcatheter Mitral Valve Repair for Functional Mitral Regurgitation: Coronary Sinus Approach. J Interv Cardiol 2007; 20:495-508. [DOI: 10.1111/j.1540-8183.2007.00310.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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David TE. Mitral Valve Repair. Ann Thorac Surg 2007; 84:1066-8. [PMID: 17726775 DOI: 10.1016/j.athoracsur.2006.09.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Tirone E David
- Peter Munk Cardiac Centre at the University Health Network, and University of Toronto, Toronto, Ontario, Canada.
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Anwar AM, Soliman OII, Nemes A, Germans T, Krenning BJ, Geleijnse ML, Van Rossum AC, ten Cate FJ. Assessment of Mitral Annulus Size and Function by Real-time 3-Dimensional Echocardiography in Cardiomyopathy: Comparison with Magnetic Resonance Imaging. J Am Soc Echocardiogr 2007; 20:941-8. [PMID: 17555937 DOI: 10.1016/j.echo.2007.01.026] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2006] [Indexed: 11/21/2022]
Abstract
OBJECTIVE We sought to assess mitral annular (MA) size and function in hypertrophic cardiomyopathy (HCM) and dilated cardiomyopathy (DCM) using real-time 3-dimensional (3D) echocardiography (RT3DE). METHODS The study included 30 patients with HCM, 20 patients with DCM, and 30 control subjects. RT3DE measurements included end-systolic and end-diastolic MA area (MAA) (MAA(3D)), MA diameter(3D), MA fractional area change (MAFAC), and MA fractional shortening. In subgroup of 50 patients, magnetic resonance imaging (MRI) was used for MAA(MRI) and MA diameter(MRI) measurement. RESULTS End-diastolic MAA(3D) was larger in HCM than in control group (P < .0001). Higher MAFAC and MA fractional shortening were present in HCM than in control group (P = .001 and P = .006, respectively). End-systolic and end-diastolic MAA(3D) in DCM were higher than in HCM and control groups (P < .0001). Lower MAFAC and MA fractional shortening were present in DCM than in HCM and control groups (P < .0001). MAFAC correlated well with left ventricular function in control subjects (r = 0.94, P < .0001), whereas correlation was less in DCM (r = 0.53, P = .02) and HCM (r = 0.42, P < .01). RT3DE and MRI measurements were comparable. CONCLUSION RT3DE assessment of MA size and function in control subjects and patients with cardiomyopathy is accurate and well correlated with MRI.
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Affiliation(s)
- Ashraf M Anwar
- Cardiology Department, Al-Husein University Hospital, Al-Azhar University, Cairo, Egypt
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Mihalatos DG, Joseph S, Gopal A, Bercow N, Toole R, Passick M, Grimson R, Norales A, Reichek N. Mitral Annular Remodeling with Varying Degrees and Mechanisms of Chronic Mitral Regurgitation. J Am Soc Echocardiogr 2007; 20:397-404. [PMID: 17400119 DOI: 10.1016/j.echo.2006.09.015] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2006] [Indexed: 11/25/2022]
Abstract
HYPOTHESES Degree of mitral annular remodeling is directly associated with severity of chronic mitral regurgitation (MR). Mitral annular remodeling occurs in a symmetric fashion, regardless of MR severity. In addition to MR severity, MR mechanism plays a significant role in mitral annular remodeling. BACKGROUND Limited data exists on mitral annular remodeling in patients with MR. Identification of annular changes may be important in aiding surgical repair. METHODS Mitral annular dimensions (anteroposterior, intercommissural, surface area, and circumference) were measured in end systole and diastole using 3-dimensional reconstructive software in 83 patients: trace to no MR (23), mild MR (15), moderate MR (26), and severe MR (19). Annular sphericity indices were determined by dividing intercommissural by anteroposterior dimensions. Patients were further subgrouped by mechanism of MR. RESULTS With increasing MR severity, there was a corresponding increase in all annular measurements, most pronounced in the anteroposterior dimension, circumference, and area. Larger increases were seen in patients with prolapse/flail and dilated mechanisms. Furthermore, the mitral annulus became more circular (sphericity index approached 1.0) with increasing MR severity. Patients with prolapse/flail mechanisms exhibited normal left ventricular volumes despite significant annular enlargement. CONCLUSIONS Mitral annular remodeling is directly associated with MR severity and occurs in an asymmetric fashion, yet is not limited to one region of the annulus. Mechanism of MR plays a significant role in annular remodeling. Annular remodeling can occur independently of left ventricular remodeling.
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Anwar AM, Soliman OII, ten Cate FJ, Nemes A, McGhie JS, Krenning BJ, van Geuns RJ, Galema TW, Geleijnse ML. True mitral annulus diameter is underestimated by two-dimensional echocardiography as evidenced by real-time three-dimensional echocardiography and magnetic resonance imaging. Int J Cardiovasc Imaging 2006; 23:541-7. [PMID: 17164985 DOI: 10.1007/s10554-006-9181-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2006] [Accepted: 10/09/2006] [Indexed: 10/23/2022]
Abstract
BACKGROUND Mitral annulus assessment is of great importance for the diagnosis and treatment of mitral valve disease. The present study sought to assess the value of real-time three-dimensional echocardiography for the assessment of true mitral annulus diameter (MAD). METHODS One hundred and fifty patients (mean age 38 +/- 18 years) with adequate two-dimensional (2D) echocardiographic image quality underwent assessment of MAD(2D) and MAD(3D) (with real-time three-dimensional echocardiography). In a subgroup of 30 patients true MAD was validated with magnetic resonance imaging (MRI). RESULTS There was a good interobserver agreement for MAD(2D) (mean difference = -0.25 +/- 2.90 mm, agreement: -3.16, 2.66) and MAD(3D) (mean difference = 0.29 +/- 2.03, agreement = -1.74, 2.32). Measurements of MAD(2D) and MAD(3D) were well correlated (R = 0.81, P < 0.0001). However, MAD(3D) was significantly larger than MAD(2D) (3.7 +/- 0.9 vs. 3.3 +/- 0.8 cm, P < 0.0001). In the subgroup of 30 patients with MRI validation, MAD(3D) and MAD(MRI) were significantly larger than MAD(2D) (3.3 +/- 0.5 and 3.4 +/- 0.5 cm vs. 2.9 +/- 0.4 cm, both P < 0.001). There was no significant difference between MAD(MRI) and MAD(3D). CONCLUSION MAD(3D) can be reliably measured and is superior to MAD(2D) in the assessment of true mitral annular size.
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Affiliation(s)
- Ashraf M Anwar
- Thoraxcenter, Room Ba 302, Erasmus MC, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
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