Why the study?
The study aimed to quantify mitral valve annulus dynamics, shape, and anatomical orifice area throughout the cardiac cycle using 4-dimensional analysis software in patients with primary and secondary mitral regurgitation compared to healthy controls.
Does 4-dimensional mitral valve analysis reveal differences in dynamic mitral valve geometry between patients with primary or secondary mitral regurgitation and healthy controls?
Does 4-dimensional mitral valve analysis reveal differences in dynamic mitral valve geometry between patients with primary or secondary mitral regurgitation and healthy controls?
4-dimensional mitral valve analysis reveals that mitral regurgitation is associated with a less dynamic, planar, and dilated annulus, and suggests the intertrigonal distance may be useful for predicting annuloplasty ring sizing.
4D mitral analysis links MR to altered annular dynamics; leaves open whether intertrigonal distance aids annuloplasty sizing.
OBJECTIVES: The goal of this study was to quantify the mitral valve (MV) annulus, the MV shape and the anatomical MV orifice area throughout the cardiac cycle using 4-dimensional MV analysis software in patients with primary mitral regurgitation (PMR) and secondary mitral regurgitation (SMR) in comparison to a healthy control group. METHODS: Three-dimensional transoesophageal echocardiograms of the MV were acquired for 29 patients with PMR, for 28 patients with SMR and for 18 healthy control subjects. The MV was quantified with regards to anterior-posterior and lateromedial diameter, annular area and circumference, intertrigonal (IT) distance, annular sphericity index, annular height to commissural width ration, and anatomical MV orifice area throughout the cardiac cycle using 3-dimensional transoesophageal echocardiography-based 4-dimensional MV advanced analysis software. RESULTS: Normal annulus dynamics display a systolic enlargement followed by an early-diastolic plateau phase and a late-diastolic contraction. The IT distance showed a linear association with the anterior-posterior diameter (= 1.11 × IT distance) and lateromedial diameter (= 1.44 × IT distance) in the control subjects. Mitral regurgitation is associated with a less dynamic, planar and dilated annulus with small variations between PMR and SMR. The IT distance was less affected by mitral regurgitation compared to the control subjects. CONCLUSIONS: The novel 4-dimensional MV analysis allows new insights into the dynamic MV geometry in patients with PMR and SMR compared to the control subjects. The IT distance may be used to predict annuloplasty ring sizing.
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Noack et al. (2019) studied this question.
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