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
PY - 2016/3/1
Y1 - 2016/3/1
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 cm2/m2, 6.0 ± 1.3 cm2/m2, and 7.3 ± 1.7 cm2/m2; perimeter index 59 ± 5 mm/m2, 67 ± 9 mm/m2, and 75 ± 10 mm/m2; intercommissural distance index 20.2 ± 1.9 mm/m2, 21.2 ± 3.1 mm/m2, and 24.7 ± 3.2 mm/m2; septal-to-lateral distance index 14.8 ± 1.6, 18.1 ± 3.3, and 19.5 ± 3.4 mm/m2 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 cm2 vs. 11.0 ± 2.3 cm2; 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.
AB - 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 cm2/m2, 6.0 ± 1.3 cm2/m2, and 7.3 ± 1.7 cm2/m2; perimeter index 59 ± 5 mm/m2, 67 ± 9 mm/m2, and 75 ± 10 mm/m2; intercommissural distance index 20.2 ± 1.9 mm/m2, 21.2 ± 3.1 mm/m2, and 24.7 ± 3.2 mm/m2; septal-to-lateral distance index 14.8 ± 1.6, 18.1 ± 3.3, and 19.5 ± 3.4 mm/m2 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 cm2 vs. 11.0 ± 2.3 cm2; 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.
KW - computed tomography
KW - mitral annulus
KW - mitral regurgitation
KW - TMVI
KW - TMVR
KW - transcatheter mitral valve implantation
UR - http://www.scopus.com/inward/record.url?scp=84960348232&partnerID=8YFLogxK
U2 - 10.1016/j.jcmg.2015.08.022
DO - 10.1016/j.jcmg.2015.08.022
M3 - Article
C2 - 26897676
AN - SCOPUS:84960348232
SN - 1936-878X
VL - 9
SP - 269
EP - 280
JO - JACC: Cardiovascular Imaging
JF - JACC: Cardiovascular Imaging
IS - 3
ER -