Mitral Annular Dimensions and Geometry in Patients With Functional Mitral Regurgitation and Mitral Valve Prolapse: Implications for Transcatheter Mitral Valve Implantation.JACC Cardiovasc Imaging 2016; 9(3):269-80JC
Abstract
OBJECTIVES
The aims of this study were to determine D-shaped mitral annulus (MA) dimensions in control subjects without significant cardiac disease and in patients with moderate to severe mitral regurgitation (MR) being considered for transcatheter mitral therapy and to determine predictors of annular size, using cardiac computed tomography.
BACKGROUND
The recently introduced D-shaped method of MA segmentation represents a biomechanically appropriate approach for annular sizing prior to transcatheter mitral valve implantation.
METHODS
Patients who had retrospectively gated cardiac computed tomography performed at our institution (2012 to 2014) and were free of significant cardiac disease were included as controls (n = 88; 56 ± 11 years of age; 47% female) and were compared with patients with moderate or severe MR due to functional mitral regurgitation (FMR) (n = 27) or mitral valve prolapse (MVP) (n = 32). MA dimensions (projected area, perimeter, intercommissural, and septal-to-lateral distance), maximal left atrial (LA) volumes, and phasic left ventricular volumes were measured.
RESULTS
MA dimensions were larger in patients with FMR or MVP compared with controls (area index 4.7 ± 0.6 cm(2)/m(2), 6.0 ± 1.3 cm(2)/m(2), and 7.3 ± 1.7 cm(2)/m(2); perimeter index 59 ± 5 mm/m(2), 67 ± 9 mm/m(2), and 75 ± 10 mm/m(2); intercommissural distance index 20.2 ± 1.9 mm/m(2), 21.2 ± 3.1 mm/m(2), and 24.7 ± 3.2 mm/m(2); septal-to-lateral distance index 14.8 ± 1.6, 18.1 ± 3.3, and 19.5 ± 3.4 mm/m(2) in controls and patients with FMR and MVP, respectively; p < 0.05 between controls and MR subgroups). Absolute MA area was 18% larger in patients with MVP than patients with FMR (13.0 ± 2.9 cm(2) vs. 11.0 ± 2.3 cm(2); p = 0.006). Although LA and left ventricular volumes were both independently associated with MA area index in controls and patients with MVP, only LA volume was associated with annular size in patients with FMR.
CONCLUSIONS
Moderate to severe MR was associated with increased MA dimensions, especially among patients with MVP compared with control subjects without cardiac disease. Moreover, unlike in controls and patients with MVP, annular enlargement in FMR was more closely associated with LA dilation.
MeSH
AgedCardiac CatheterizationCardiac-Gated Imaging TechniquesFemaleHeart AtriaHeart Valve Prosthesis ImplantationHemodynamicsHumansMaleMiddle AgedMitral ValveMitral Valve InsufficiencyMitral Valve ProlapseMultidetector Computed TomographyPatient SelectionPredictive Value of TestsRetrospective StudiesSeverity of Illness Index
Pub Type(s)
Journal Article
Language
eng
PubMed ID
26897676
Citation
Naoum, Christopher, et al. "Mitral Annular Dimensions and Geometry in Patients With Functional Mitral Regurgitation and Mitral Valve Prolapse: Implications for Transcatheter Mitral Valve Implantation." JACC. Cardiovascular Imaging, vol. 9, no. 3, 2016, pp. 269-80.
Naoum C, Leipsic J, Cheung A, et al. Mitral Annular Dimensions and Geometry in Patients With Functional Mitral Regurgitation and Mitral Valve Prolapse: Implications for Transcatheter Mitral Valve Implantation. JACC Cardiovasc Imaging. 2016;9(3):269-80.
Naoum, C., Leipsic, J., Cheung, A., Ye, J., Bilbey, N., Mak, G., ... Blanke, P. (2016). Mitral Annular Dimensions and Geometry in Patients With Functional Mitral Regurgitation and Mitral Valve Prolapse: Implications for Transcatheter Mitral Valve Implantation. JACC. Cardiovascular Imaging, 9(3), pp. 269-80. doi:10.1016/j.jcmg.2015.08.022.
Naoum C, et al. Mitral Annular Dimensions and Geometry in Patients With Functional Mitral Regurgitation and Mitral Valve Prolapse: Implications for Transcatheter Mitral Valve Implantation. JACC Cardiovasc Imaging. 2016;9(3):269-80. PubMed PMID: 26897676.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR
T1 - Mitral Annular Dimensions and Geometry in Patients With Functional Mitral Regurgitation and Mitral Valve Prolapse: Implications for Transcatheter Mitral Valve Implantation.
AU - Naoum,Christopher,
AU - Leipsic,Jonathon,
AU - Cheung,Anson,
AU - Ye,Jian,
AU - Bilbey,Nicolas,
AU - Mak,George,
AU - Berger,Adam,
AU - Dvir,Danny,
AU - Arepalli,Chesnal,
AU - Grewal,Jasmine,
AU - Muller,David,
AU - Murphy,Darra,
AU - Hague,Cameron,
AU - Piazza,Nicolo,
AU - Webb,John,
AU - Blanke,Philipp,
Y1 - 2016/02/17/
PY - 2015/07/02/received
PY - 2015/08/18/revised
PY - 2015/08/20/accepted
PY - 2016/2/22/entrez
PY - 2016/2/22/pubmed
PY - 2016/12/15/medline
KW - TMVI
KW - TMVR
KW - computed tomography
KW - mitral annulus
KW - mitral regurgitation
KW - transcatheter mitral valve implantation
SP - 269
EP - 80
JF - JACC. Cardiovascular imaging
JO - JACC Cardiovasc Imaging
VL - 9
IS - 3
N2 - OBJECTIVES: The aims of this study were to determine D-shaped mitral annulus (MA) dimensions in control subjects without significant cardiac disease and in patients with moderate to severe mitral regurgitation (MR) being considered for transcatheter mitral therapy and to determine predictors of annular size, using cardiac computed tomography. BACKGROUND: The recently introduced D-shaped method of MA segmentation represents a biomechanically appropriate approach for annular sizing prior to transcatheter mitral valve implantation. METHODS: Patients who had retrospectively gated cardiac computed tomography performed at our institution (2012 to 2014) and were free of significant cardiac disease were included as controls (n = 88; 56 ± 11 years of age; 47% female) and were compared with patients with moderate or severe MR due to functional mitral regurgitation (FMR) (n = 27) or mitral valve prolapse (MVP) (n = 32). MA dimensions (projected area, perimeter, intercommissural, and septal-to-lateral distance), maximal left atrial (LA) volumes, and phasic left ventricular volumes were measured. RESULTS: MA dimensions were larger in patients with FMR or MVP compared with controls (area index 4.7 ± 0.6 cm(2)/m(2), 6.0 ± 1.3 cm(2)/m(2), and 7.3 ± 1.7 cm(2)/m(2); perimeter index 59 ± 5 mm/m(2), 67 ± 9 mm/m(2), and 75 ± 10 mm/m(2); intercommissural distance index 20.2 ± 1.9 mm/m(2), 21.2 ± 3.1 mm/m(2), and 24.7 ± 3.2 mm/m(2); septal-to-lateral distance index 14.8 ± 1.6, 18.1 ± 3.3, and 19.5 ± 3.4 mm/m(2) in controls and patients with FMR and MVP, respectively; p < 0.05 between controls and MR subgroups). Absolute MA area was 18% larger in patients with MVP than patients with FMR (13.0 ± 2.9 cm(2) vs. 11.0 ± 2.3 cm(2); p = 0.006). Although LA and left ventricular volumes were both independently associated with MA area index in controls and patients with MVP, only LA volume was associated with annular size in patients with FMR. CONCLUSIONS: Moderate to severe MR was associated with increased MA dimensions, especially among patients with MVP compared with control subjects without cardiac disease. Moreover, unlike in controls and patients with MVP, annular enlargement in FMR was more closely associated with LA dilation.
SN - 1876-7591
UR - https://www.unboundmedicine.com/medline/citation/26897676/Mitral_Annular_Dimensions_and_Geometry_in_Patients_With_Functional_Mitral_Regurgitation_and_Mitral_Valve_Prolapse:_Implications_for_Transcatheter_Mitral_Valve_Implantation_
L2 - https://linkinghub.elsevier.com/retrieve/pii/S1936-878X(15)00982-1
DB - PRIME
DP - Unbound Medicine
ER -
