Automatic transesophageal echocardiographic evaluation of patients with mitral valve prolapse: comparison with patients without structural cardiac chamber remodeling (an exploratory study)

Q: What are the key findings of this study?

Automated 3D transesophageal echocardiography parameters of the mitral valve apparatus differed significantly (27 out of 34 parameters) between patients with mitral valve prolapse and those without structural cardiac chamber remodeling.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Mitral valve prolapse with moderate to severe mitral regurgitation (n=102). Intervention: Mitral valve prolapse (moderate to severe mitral regurgitation) vs. Patent foramen ovale without structural cardiac chamber alterations. Primary outcome: Differences in 34 automatic morphofunctional parameters of the mitral valve apparatus evaluated by 3D TEE (p=<0.05).

Q: What does this research mean for the field?

Automated 3D transesophageal echocardiography parameters of the mitral valve apparatus differ significantly between patients with mitral valve prolapse and controls without structural cardiac chamber remodeling, capturing distinct annular and leaflet geometry. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Marcelo Luiz Campos Vieira; Ana C T Rodrigues; Edgar Daminello; Adriana Reche; Gustavo P Almeida; Alessandra J. Oliveira; Luiz O A Santos; Rafael Bonafim Piveta; Rodrigo A. C. Meirelles; Claudia Gianini Monaco; Fernando C Oliveira; Fernando Amilcar Solis; Wercules Antonio Alves de Oliveira; Alessandro Cavalcanti Lianza; Adriana Sañudo; Edgar Bezerra Lira Filho; Sergio Augusto Fudaba Curcio; Robinson Poffo; Cláudio Henrique Fischer; Samira Saady Morhy

doi:10.21037/jtd-2026-1300

Key result

Automated 3D TEE distinguishes mitral valve prolapse by altering ~79% of apparatus morphofunctional parameters.

P<0.05
n=102

Figures

Why the study?

There is limited information on automatic mitral valve apparatus analysis using 3D TEE software in patients with mitral valve prolapse compared to those without structural cardiac chamber remodeling.

Does automated 3D transesophageal echocardiography software identify structural differences in the mitral valve apparatus between patients with mitral valve prolapse and those without structural remodeling?

Study Design

Type

Cohort (n=102)

Multicenter

No

Structured PICO

Does automated 3D transesophageal echocardiography software identify structural differences in the mitral valve apparatus between patients with mitral valve prolapse and those without structural remodeling?

P

Population

102 adults (mean age 57.2, 42.2% female) comprising 59 patients with moderate to severe mitral regurgitation due to MVP and 43 patients with PFO without structural remodeling undergoing 3D transesophageal echocardiography.

E

Exposure

Moderate to severe mitral valve regurgitation due to mitral valve prolapse (evaluated via automated 3D transesophageal echocardiography software, Philips QLAB 15.0.0)

C

Comparator

Patent foramen ovale without structural cardiac chamber alterations (evaluated via the same automated 3D TEE software)

O

Outcome

Differences in 34 automatic parameters of the mitral valve apparatus (including diameters, area, perimeter, height, angle, coaptation width)surrogate

Main Result

p-value: p=<0.05

Automated 3D TEE software can reliably identify distinct morphofunctional changes in the mitral valve apparatus in patients with mitral valve prolapse, potentially aiding in surgical planning.

Limitations

Small sample size from a single-center tertiary hospital
Automated measurements were not validated against an independent reference standard (e.g., surgical findings, expert manual measurement, cardiac MRI)
Subgroup analyses based on the 75th percentile of ERO included a limited number of patients
Groups were matched only by body surface area, leaving potential residual confounding from age and sex
Evaluated using a single commercially available software platform
Small sample single center
Did not evaluate absolute accuracy against independent reference standards (e.g., surgical findings or MRI)
Subgroup analyses had limited statistical power
Matching based only on body surface (not age/sex)
Only one software platform evaluated

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Implication

May support automated mitral assessment in prolapse; leaves open impact on surgical planning or outcomes.

Abstract

Background: There is a paucity of information concerning automatic mitral valve apparatus (MVA) analysis of patients with mitral valve prolapse (MVP). We aimed to study with an automatic three-dimensional (3D) transesophageal echocardiography (TEE)-dedicated software, patients with moderate and severe mitral regurgitation when compared to patients with no structural cardiac chamber alterations [patients with patent foramen ovale (PFO) who underwent TEE]. Methods: We employed TEE software dedicated to automatic analysis of 34 parameters of the MVA, comparing MVP patients with moderate and severe mitral regurgitation and patients with PFO without cardiac chamber structural alterations. Mitral valve effective regurgitant orifice (ERO) and regurgitant volume were correlated to automatic MVP parameters. Results: Fifty-nine MVP patients and 43 PFO patients were analyzed. All MVP patients presented P2 MVP, 15 (25.4%) with both posterior and anterior prolapse. Twenty-seven automatic parameters (79%) were different concerning MVP and PFO patients (P<0.05): diameters, area, perimeter, height, angle, coaptation width, length, closure line length, and annulus. ERO was 0.43±0.11 cm2, and regurgitant volume was 62.2±14.9 mL/beat. Automatic analysis correlated to 75th percentile ERO MVP patients (ERO >0.48 cm2): posterior leaflet area (r=0.74, P=0.03); posterior leaflet length (r=0.73, P=0.03); tenting area (r=0.41, P=0.048). Conclusions: Automatic mitral valve parameters differed significantly between patients with MVP and those without structural cardiac chamber remodeling. In exploratory analysis, patients in the upper range of ERO values (≥75th percentile) showed patterns involving posterior leaflet geometry that were consistent with the associations observed in continuous-variable analysis. These findings support the potential role of automated 3D assessment in the anatomical characterization of MVP.

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Cite This Study

Vieira et al. (2026) conducted a cohort in Mitral valve prolapse with moderate to severe mitral regurgitation (n=102). Mitral valve prolapse (moderate to severe mitral regurgitation) vs. Patent foramen ovale without structural cardiac chamber alterations was evaluated on Differences in 34 automatic morphofunctional parameters of the mitral valve apparatus evaluated by 3D TEE (p=<0.05). Automated 3D transesophageal echocardiography parameters of the mitral valve apparatus differed significantly (27 out of 34 parameters) between patients with mitral valve prolapse and those without structural cardiac chamber remodeling.

synapsesocial.com/papers/6ad0fd8e15427f6a84040696 https://doi.org/10.21037/jtd-2026-1300

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Automatic transesophageal echocardiographic evaluation of patients with mitral valve prolapse: comparison with patients without structural cardiac chamber remodeling (an exploratory study)

Figures

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Automatic transesophageal echocardiographic evaluation of patients with mitral valve prolapse: comparison with patients without structural cardiac chamber remodeling (an exploratory study)

Figures

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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