Key result
Patients with dilated cardiomyopathy had a significantly larger mitral annulus area (11.5 vs 5.5 cm/m) and smaller apicobasal motion compared to healthy subjects (P<0.001).
Why the study?
How do the 3D shape, size, and motion of the mitral annulus differ between healthy subjects, patients with DCM, and patients with HOCM when assessed by CT?
Observational (n=50)
How do the 3D shape, size, and motion of the mitral annulus differ between healthy subjects, patients with DCM, and patients with HOCM when assessed by CT?
Absolute Event Rate: 11.5% vs 5.5%
p-value: p=<0.001
CT imaging demonstrates that the mitral annulus is significantly larger and has reduced motion in patients with dilated cardiomyopathy compared to healthy subjects and those with hypertrophic obstructive cardiomyopathy.
Larger mitral annulus with reduced motion in DCM may aid CT interpretation; leaves open prognostic or therapeutic relevance pending outcome studies.
OBJECTIVE: To assess prospectively, in healthy subjects and in patients with dilated cardiomyopathy (DCM) and hypertrophic obstructive cardiomyopathy (HOCM), the 3-dimensional (3D) shape, size, and motion of the mitral annulus (MA) using computed tomography (CT). MATERIALS AND METHODS: Twenty patients with no cardiac abnormalities (referred to as normals), 15 with DCM, and 15 with HOCM as determined by echocardiography underwent contrast-enhanced, retrospectively electrocardiography (ECG)-gated 64-slice CT of the heart. The MA was manually segmented in 10% steps of the RR interval with dedicated 3D software employing the point-wrap algorithm. The MA shape, area size, change of the MA area, and apicobasal MA motion throughout the cardiac cycle was determined and compared between the groups. Intercommissural distances were measured with CT and compared with findings during surgery in 9 patients undergoing ring annuloplasty. RESULTS: The MA was nonplanar in all phases and subjects, being largest in diastole and smallest in systole. The MA area was significantly (P < 0.001) larger in patients with DCM (11.5 +/- 4.1 cm/m) as compared with normals (5.5 +/- 0.9 cm/m) and HOCM (4.7 +/- 0.9 cm/m). The change of MA area throughout the cardiac cycle was significantly (P < 0.017) smaller in patients with DCM (12.2 +/- 3.3%/m) as compared with normals (20.0 +/- 7.9%/m) and HOCM (20.5 +/- 7.7%/m). The mean apicobasal motion was significantly (P < 0.017) smaller in patients with DCM (2.2 +/- 1.0 mm/m) as compared with normals (3.6 +/- 0.8 mm/m) and HOCM (2.7 +/- 0.7 mm/m). Intercommissural distances as determined by CT showed a good correlation (r = 0.68, P < 0.05) with intraoperative measurements (mean difference, 0.44 mm; limits of agreement, -2.73-3.62 mm). CONCLUSION: Our study provides in vivo human data on the 3D shape, size, and motion of the MA in healthy subjects. Significant changes in size and motion of the MA were noted in patients with HOCM.
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Alkadhi et al. (2009) conducted an observational in Dilated cardiomyopathy and hypertrophic obstructive cardiomyopathy (n=50). Cardiomyopathy (DCM and HOCM) vs. Healthy subjects with no cardiac abnormalities was evaluated on Mitral annulus area size (p=<0.001). Patients with dilated cardiomyopathy had a significantly larger mitral annulus area (11.5 vs 5.5 cm/m) and smaller apicobasal motion compared to healthy subjects (P<0.001).
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