Key result
Degenerative MR flail cases exhibit increased mitral annular excursion compared to normal valves.
Why the study?
Mitral annulus dynamics are abnormal in mitral regurgitation and vary by etiology, with annular contractility impairment tied to loss of physiologic morphology.
Does real-time four-dimensional transesophageal echocardiography reveal differences in mitral annulus functional changes between functional and degenerative mitral regurgitation compared to normal mitral valves?
Observational (n=231)
Does real-time four-dimensional transesophageal echocardiography reveal differences in mitral annulus functional changes between functional and degenerative mitral regurgitation compared to normal mitral valves?
p-value: p=<0.0001
RT4D-TEE demonstrates that mitral annulus function is impaired in functional MR but exhibits increased velocities in degenerative MR, particularly in patients with flail leaflets.
Increased MAE in flail degenerative MR supports distinct annular mechanics; leaves open whether RT4D-TEE metrics guide intervention.
Background The mitral annulus (MA) is a fibrous structure with anteroposterior contraction and increased annular height accentuating the annular saddle shape during systole. MA dynamics are abnormal in patients with mitral regurgitation (MR) and change according to the underlying etiology. Annular contractility damage is associated with the loss of physiologic morphology. Four-dimensional transesophageal echocardiography (RT4D-TEE) is an appropriate imaging technique for the quantification of these functional changes. Purpose The study aimed to evaluate echocardiographic MA functional features according to MR etiology. Methods The study included 191 patients with MR, 97 patients with functional (FMR), 94 with degenerative mitral regurgitation (DMR), and 40 subjects with normal mitral valve (MV). All patients diagnosed with MR by transthoracic echocardiography (TTE) underwent a comprehensive real-time four-dimensional transesophageal echocardiography (RT4D-TEE) evaluation of the MV apparatus. The images were acquired by a commercial ultrasound system. The analysis was performed offline by EchoPAC version 204 with a Four-Dimensional Automated Mitral Valve Quantification (4D Auto MVQ) software. The study measured mitral annular excursion (MAE), mitral annular max velocity (MAV), and annular area (2D) fraction (AAF). Results 1. Degenerative group was divided into Barlow disease – 29 (30.85%) patients, prolapse of one or two leaflet segments - 33 (35,10%) patients, and flail -34 (36.17%) patients. 2. Patients with FMR presented reduced values of MA functional parameters compared with patients with normal MV: MAE 4.07 mm/s (SD 1.96), p < 0.0001, MAV 27 mm/s (SD 9.62), p = 0.0001, AAF -0.29% (SD 1.4), p = 0.0003. 3. Subjects with DMR had increased values of mitral MA functional parameters compared with those with normal MV: MAE 5.94 mm/s (SD 2.48), p = 0.3494, MAV 39.07mm/s (SD 13.54), p = 0.0580, AAF -0.15% (SD 1.91), p = 0.0010. 4. In the DMR group, MA function was increased as follows: in case of MV prolapse: MAE 4.76 mm/s (SD 2.12), MAE 31.1mm/s (SD 6), AAF -0,1% (SD 1.53); in Barlow disease: MAE 4.96mm/s (1.74), MAE 35.04 mm/s (SD 9.85), AAF -0.11% (SD 1.22),, in patients with flail MAE 7.8 mm/s (SD 2.21), MAV 50.02 mm/s (SD 14.32), AAF -0.24% (SD 2.62). Conclusions 1. The MA function is damaged in FMR and DMR compared with normal MV. 2. MA velocities are increased in Barlow disease and patients with flail compared to patients with MV prolapse. 3. The subjects with MV flail presented the highest MA velocities.
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Toader et al. (2026) conducted an observational in Mitral regurgitation (n=231). Functional and degenerative mitral regurgitation vs. Normal mitral valve was evaluated on Mitral annular excursion (MAE) in functional mitral regurgitation (p=<0.0001). Functional mitral regurgitation was associated with significantly reduced mitral annular excursion (4.07 mm/s, P<0.0001) compared to normal valves, while flail leaflets showed the highest velocities.
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