Morphofunctional Abnormalities of Mitral Annulus and Arrhythmic Mitral Valve Prolapse
Arrhythmic mitral valve prolapse (MVP) is characterized by myxomatous leaflets and left ventricular (LV) fibrosis of papillary muscles and inferobasal wall. We searched for morphofunctional abnormalities of the mitral valve that could explain a regional mechanical myocardial stretch. Thirty-six (27...
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| Veröffentlicht in: | Circulation. Cardiovascular imaging 2016-08, Vol.9 (8), p.e005030-e005030 |
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| creator | Perazzolo Marra, Martina Basso, Cristina De Lazzari, Manuel Rizzo, Stefania Cipriani, Alberto Giorgi, Benedetta Lacognata, Carmelo Rigato, Ilaria Migliore, Federico Pilichou, Kalliopi Cacciavillani, Luisa Bertaglia, Emanuele Frigo, Anna Chiara Bauce, Barbara Corrado, Domenico Thiene, Gaetano Iliceto, Sabino |
| description | Arrhythmic mitral valve prolapse (MVP) is characterized by myxomatous leaflets and left ventricular (LV) fibrosis of papillary muscles and inferobasal wall. We searched for morphofunctional abnormalities of the mitral valve that could explain a regional mechanical myocardial stretch.
Thirty-six (27 female patients; median age: 44 years) arrhythmic MVP patients with LV late gadolinium enhancement on cardiac magnetic resonance and no or trivial mitral regurgitation, and 16 (6 female patients; median age: 40 years) MVP patients without LV late gadolinium enhancement were investigated by morphofunctional cardiac magnetic resonance. Mitral annulus disjunction (median: 4.8 versus 1.8 mm; P |
| doi_str_mv | 10.1161/CIRCIMAGING.116.005030 |
| format | Article |
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Thirty-six (27 female patients; median age: 44 years) arrhythmic MVP patients with LV late gadolinium enhancement on cardiac magnetic resonance and no or trivial mitral regurgitation, and 16 (6 female patients; median age: 40 years) MVP patients without LV late gadolinium enhancement were investigated by morphofunctional cardiac magnetic resonance. Mitral annulus disjunction (median: 4.8 versus 1.8 mm; P<0.001), end-systolic mitral annular diameters (median: 41.2 versus 31.5; P=0.004) and end-diastolic mitral annular diameters (median: 35.5 versus 31.5; P=0.042), prevalence of posterior systolic curling (34 [94%] versus 3 [19%]; P<0.001), and basal to mid LV wall thickness ratio >1.5 (22 [61%] versus 4 [25%]; P=0.016) were higher in MVP patients with late gadolinium enhancement than in those without. A linear correlation was found between mitral annulus disjunction and curling (R=0.85). A higher prevalence of auscultatory midsystolic click (26 [72%] versus 6 [38%]; P=0.018) was also noted. Histology of the mitral annulus showed a longer mitral annulus disjunction in 50 sudden death patients with MVP and LV fibrosis than in 20 patients without MVP (median: 3 versus 1.5 mm; P<0.001).
Mitral annulus disjunction is a constant feature of arrhythmic MVP with LV fibrosis. The excessive mobility of the leaflets caused by posterior systolic curling accounts for a mechanical stretch of the inferobasal wall and papillary muscles, eventually leading to myocardial hypertrophy and scarring. These mitral annulus abnormalities, together with auscultatory midsystolic click, may identify MVP patients who would need arrhythmic risk stratification.</description><identifier>ISSN: 1941-9651</identifier><identifier>EISSN: 1942-0080</identifier><identifier>DOI: 10.1161/CIRCIMAGING.116.005030</identifier><identifier>PMID: 27516479</identifier><language>eng</language><publisher>United States: Lippincott Williams & Wilkins</publisher><subject>Adult ; Arrhythmias, Cardiac - complications ; Arrhythmias, Cardiac - diagnostic imaging ; Arrhythmias, Cardiac - mortality ; Arrhythmias, Cardiac - physiopathology ; Biopsy ; Contrast Media - administration & dosage ; Death, Sudden, Cardiac - etiology ; Echocardiography ; Electrocardiography, Ambulatory ; Female ; Fibrosis ; Heart Ventricles - diagnostic imaging ; Heart Ventricles - physiopathology ; Humans ; Hypertrophy, Left Ventricular - diagnostic imaging ; Hypertrophy, Left Ventricular - etiology ; Hypertrophy, Left Ventricular - mortality ; Hypertrophy, Left Ventricular - physiopathology ; Linear Models ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Mitral Valve - diagnostic imaging ; Mitral Valve - physiopathology ; Mitral Valve Prolapse - diagnostic imaging ; Mitral Valve Prolapse - etiology ; Mitral Valve Prolapse - mortality ; Mitral Valve Prolapse - physiopathology ; Original ; Papillary Muscles - diagnostic imaging ; Papillary Muscles - physiopathology ; Prognosis ; Risk Factors ; Ventricular Function, Left ; Young Adult</subject><ispartof>Circulation. Cardiovascular imaging, 2016-08, Vol.9 (8), p.e005030-e005030</ispartof><rights>2016 The Authors.</rights><rights>2016 The Authors. 2016</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c414t-e157f4ab0abe2c6c918bd579995e048968238f9a530303b55491cb1c45f6f11d3</citedby><cites>FETCH-LOGICAL-c414t-e157f4ab0abe2c6c918bd579995e048968238f9a530303b55491cb1c45f6f11d3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,776,780,881,3674,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27516479$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Perazzolo Marra, Martina</creatorcontrib><creatorcontrib>Basso, Cristina</creatorcontrib><creatorcontrib>De Lazzari, Manuel</creatorcontrib><creatorcontrib>Rizzo, Stefania</creatorcontrib><creatorcontrib>Cipriani, Alberto</creatorcontrib><creatorcontrib>Giorgi, Benedetta</creatorcontrib><creatorcontrib>Lacognata, Carmelo</creatorcontrib><creatorcontrib>Rigato, Ilaria</creatorcontrib><creatorcontrib>Migliore, Federico</creatorcontrib><creatorcontrib>Pilichou, Kalliopi</creatorcontrib><creatorcontrib>Cacciavillani, Luisa</creatorcontrib><creatorcontrib>Bertaglia, Emanuele</creatorcontrib><creatorcontrib>Frigo, Anna Chiara</creatorcontrib><creatorcontrib>Bauce, Barbara</creatorcontrib><creatorcontrib>Corrado, Domenico</creatorcontrib><creatorcontrib>Thiene, Gaetano</creatorcontrib><creatorcontrib>Iliceto, Sabino</creatorcontrib><title>Morphofunctional Abnormalities of Mitral Annulus and Arrhythmic Mitral Valve Prolapse</title><title>Circulation. Cardiovascular imaging</title><addtitle>Circ Cardiovasc Imaging</addtitle><description>Arrhythmic mitral valve prolapse (MVP) is characterized by myxomatous leaflets and left ventricular (LV) fibrosis of papillary muscles and inferobasal wall. We searched for morphofunctional abnormalities of the mitral valve that could explain a regional mechanical myocardial stretch.
Thirty-six (27 female patients; median age: 44 years) arrhythmic MVP patients with LV late gadolinium enhancement on cardiac magnetic resonance and no or trivial mitral regurgitation, and 16 (6 female patients; median age: 40 years) MVP patients without LV late gadolinium enhancement were investigated by morphofunctional cardiac magnetic resonance. Mitral annulus disjunction (median: 4.8 versus 1.8 mm; P<0.001), end-systolic mitral annular diameters (median: 41.2 versus 31.5; P=0.004) and end-diastolic mitral annular diameters (median: 35.5 versus 31.5; P=0.042), prevalence of posterior systolic curling (34 [94%] versus 3 [19%]; P<0.001), and basal to mid LV wall thickness ratio >1.5 (22 [61%] versus 4 [25%]; P=0.016) were higher in MVP patients with late gadolinium enhancement than in those without. A linear correlation was found between mitral annulus disjunction and curling (R=0.85). A higher prevalence of auscultatory midsystolic click (26 [72%] versus 6 [38%]; P=0.018) was also noted. Histology of the mitral annulus showed a longer mitral annulus disjunction in 50 sudden death patients with MVP and LV fibrosis than in 20 patients without MVP (median: 3 versus 1.5 mm; P<0.001).
Mitral annulus disjunction is a constant feature of arrhythmic MVP with LV fibrosis. The excessive mobility of the leaflets caused by posterior systolic curling accounts for a mechanical stretch of the inferobasal wall and papillary muscles, eventually leading to myocardial hypertrophy and scarring. These mitral annulus abnormalities, together with auscultatory midsystolic click, may identify MVP patients who would need arrhythmic risk stratification.</description><subject>Adult</subject><subject>Arrhythmias, Cardiac - complications</subject><subject>Arrhythmias, Cardiac - diagnostic imaging</subject><subject>Arrhythmias, Cardiac - mortality</subject><subject>Arrhythmias, Cardiac - physiopathology</subject><subject>Biopsy</subject><subject>Contrast Media - administration & dosage</subject><subject>Death, Sudden, Cardiac - etiology</subject><subject>Echocardiography</subject><subject>Electrocardiography, Ambulatory</subject><subject>Female</subject><subject>Fibrosis</subject><subject>Heart Ventricles - diagnostic imaging</subject><subject>Heart Ventricles - physiopathology</subject><subject>Humans</subject><subject>Hypertrophy, Left Ventricular - diagnostic imaging</subject><subject>Hypertrophy, Left Ventricular - etiology</subject><subject>Hypertrophy, Left Ventricular - mortality</subject><subject>Hypertrophy, Left Ventricular - physiopathology</subject><subject>Linear Models</subject><subject>Magnetic Resonance Imaging</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Mitral Valve - diagnostic imaging</subject><subject>Mitral Valve - physiopathology</subject><subject>Mitral Valve Prolapse - diagnostic imaging</subject><subject>Mitral Valve Prolapse - etiology</subject><subject>Mitral Valve Prolapse - mortality</subject><subject>Mitral Valve Prolapse - physiopathology</subject><subject>Original</subject><subject>Papillary Muscles - diagnostic imaging</subject><subject>Papillary Muscles - physiopathology</subject><subject>Prognosis</subject><subject>Risk Factors</subject><subject>Ventricular Function, Left</subject><subject>Young Adult</subject><issn>1941-9651</issn><issn>1942-0080</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpVUctOwzAQtBCIlsIvVDlySfEmdhpfkKoKSqUWEKJcLcd1qFFiBzup1L8noQ_BaVczu7OzGoSGgEcACdxN52_T-XIymz_POmCEMcUxPkN9YCQKMU7x-W8PIUso9NCV918YJzGm6SXqRWMKCRmzPlotras2Nm-MrLU1oggmmbGuFIWutfKBzYOlrl2HG9MUjQ-EWQcT5za7elNqeWQ_RLFVwauzhai8ukYXuSi8ujnUAVo9PrxPn8LFy2w-nSxCSYDUoQI6zonIsMhUJBPJIM3WdMwYowqTlCVpFKc5EzRuf4szSgkDmYEkNE9ygHU8QPd73arJSrWWynRmeOV0KdyOW6H5f8boDf-0W04Yg5jQVuD2IODsd6N8zUvtpSoKYZRtPIcUIGKtDdyOJvtR6az3TuWnM4B5lwn_k0kH8H0m7eLwr8nT2jGE-AfeHopf</recordid><startdate>201608</startdate><enddate>201608</enddate><creator>Perazzolo Marra, Martina</creator><creator>Basso, Cristina</creator><creator>De Lazzari, Manuel</creator><creator>Rizzo, Stefania</creator><creator>Cipriani, Alberto</creator><creator>Giorgi, Benedetta</creator><creator>Lacognata, Carmelo</creator><creator>Rigato, Ilaria</creator><creator>Migliore, Federico</creator><creator>Pilichou, Kalliopi</creator><creator>Cacciavillani, Luisa</creator><creator>Bertaglia, Emanuele</creator><creator>Frigo, Anna Chiara</creator><creator>Bauce, Barbara</creator><creator>Corrado, Domenico</creator><creator>Thiene, Gaetano</creator><creator>Iliceto, Sabino</creator><general>Lippincott Williams & Wilkins</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>201608</creationdate><title>Morphofunctional Abnormalities of Mitral Annulus and Arrhythmic Mitral Valve Prolapse</title><author>Perazzolo Marra, Martina ; Basso, Cristina ; De Lazzari, Manuel ; Rizzo, Stefania ; Cipriani, Alberto ; Giorgi, Benedetta ; Lacognata, Carmelo ; Rigato, Ilaria ; Migliore, Federico ; Pilichou, Kalliopi ; Cacciavillani, Luisa ; Bertaglia, Emanuele ; Frigo, Anna Chiara ; Bauce, Barbara ; Corrado, Domenico ; Thiene, Gaetano ; Iliceto, Sabino</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c414t-e157f4ab0abe2c6c918bd579995e048968238f9a530303b55491cb1c45f6f11d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Adult</topic><topic>Arrhythmias, Cardiac - complications</topic><topic>Arrhythmias, Cardiac - diagnostic imaging</topic><topic>Arrhythmias, Cardiac - mortality</topic><topic>Arrhythmias, Cardiac - physiopathology</topic><topic>Biopsy</topic><topic>Contrast Media - administration & dosage</topic><topic>Death, Sudden, Cardiac - etiology</topic><topic>Echocardiography</topic><topic>Electrocardiography, Ambulatory</topic><topic>Female</topic><topic>Fibrosis</topic><topic>Heart Ventricles - diagnostic imaging</topic><topic>Heart Ventricles - physiopathology</topic><topic>Humans</topic><topic>Hypertrophy, Left Ventricular - diagnostic imaging</topic><topic>Hypertrophy, Left Ventricular - etiology</topic><topic>Hypertrophy, Left Ventricular - mortality</topic><topic>Hypertrophy, Left Ventricular - physiopathology</topic><topic>Linear Models</topic><topic>Magnetic Resonance Imaging</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Mitral Valve - diagnostic imaging</topic><topic>Mitral Valve - physiopathology</topic><topic>Mitral Valve Prolapse - diagnostic imaging</topic><topic>Mitral Valve Prolapse - etiology</topic><topic>Mitral Valve Prolapse - mortality</topic><topic>Mitral Valve Prolapse - physiopathology</topic><topic>Original</topic><topic>Papillary Muscles - diagnostic imaging</topic><topic>Papillary Muscles - physiopathology</topic><topic>Prognosis</topic><topic>Risk Factors</topic><topic>Ventricular Function, Left</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Perazzolo Marra, Martina</creatorcontrib><creatorcontrib>Basso, Cristina</creatorcontrib><creatorcontrib>De Lazzari, Manuel</creatorcontrib><creatorcontrib>Rizzo, Stefania</creatorcontrib><creatorcontrib>Cipriani, Alberto</creatorcontrib><creatorcontrib>Giorgi, Benedetta</creatorcontrib><creatorcontrib>Lacognata, Carmelo</creatorcontrib><creatorcontrib>Rigato, Ilaria</creatorcontrib><creatorcontrib>Migliore, Federico</creatorcontrib><creatorcontrib>Pilichou, Kalliopi</creatorcontrib><creatorcontrib>Cacciavillani, Luisa</creatorcontrib><creatorcontrib>Bertaglia, Emanuele</creatorcontrib><creatorcontrib>Frigo, Anna Chiara</creatorcontrib><creatorcontrib>Bauce, Barbara</creatorcontrib><creatorcontrib>Corrado, Domenico</creatorcontrib><creatorcontrib>Thiene, Gaetano</creatorcontrib><creatorcontrib>Iliceto, Sabino</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Circulation. Cardiovascular imaging</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Perazzolo Marra, Martina</au><au>Basso, Cristina</au><au>De Lazzari, Manuel</au><au>Rizzo, Stefania</au><au>Cipriani, Alberto</au><au>Giorgi, Benedetta</au><au>Lacognata, Carmelo</au><au>Rigato, Ilaria</au><au>Migliore, Federico</au><au>Pilichou, Kalliopi</au><au>Cacciavillani, Luisa</au><au>Bertaglia, Emanuele</au><au>Frigo, Anna Chiara</au><au>Bauce, Barbara</au><au>Corrado, Domenico</au><au>Thiene, Gaetano</au><au>Iliceto, Sabino</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Morphofunctional Abnormalities of Mitral Annulus and Arrhythmic Mitral Valve Prolapse</atitle><jtitle>Circulation. Cardiovascular imaging</jtitle><addtitle>Circ Cardiovasc Imaging</addtitle><date>2016-08</date><risdate>2016</risdate><volume>9</volume><issue>8</issue><spage>e005030</spage><epage>e005030</epage><pages>e005030-e005030</pages><issn>1941-9651</issn><eissn>1942-0080</eissn><abstract>Arrhythmic mitral valve prolapse (MVP) is characterized by myxomatous leaflets and left ventricular (LV) fibrosis of papillary muscles and inferobasal wall. We searched for morphofunctional abnormalities of the mitral valve that could explain a regional mechanical myocardial stretch.
Thirty-six (27 female patients; median age: 44 years) arrhythmic MVP patients with LV late gadolinium enhancement on cardiac magnetic resonance and no or trivial mitral regurgitation, and 16 (6 female patients; median age: 40 years) MVP patients without LV late gadolinium enhancement were investigated by morphofunctional cardiac magnetic resonance. Mitral annulus disjunction (median: 4.8 versus 1.8 mm; P<0.001), end-systolic mitral annular diameters (median: 41.2 versus 31.5; P=0.004) and end-diastolic mitral annular diameters (median: 35.5 versus 31.5; P=0.042), prevalence of posterior systolic curling (34 [94%] versus 3 [19%]; P<0.001), and basal to mid LV wall thickness ratio >1.5 (22 [61%] versus 4 [25%]; P=0.016) were higher in MVP patients with late gadolinium enhancement than in those without. A linear correlation was found between mitral annulus disjunction and curling (R=0.85). A higher prevalence of auscultatory midsystolic click (26 [72%] versus 6 [38%]; P=0.018) was also noted. Histology of the mitral annulus showed a longer mitral annulus disjunction in 50 sudden death patients with MVP and LV fibrosis than in 20 patients without MVP (median: 3 versus 1.5 mm; P<0.001).
Mitral annulus disjunction is a constant feature of arrhythmic MVP with LV fibrosis. The excessive mobility of the leaflets caused by posterior systolic curling accounts for a mechanical stretch of the inferobasal wall and papillary muscles, eventually leading to myocardial hypertrophy and scarring. These mitral annulus abnormalities, together with auscultatory midsystolic click, may identify MVP patients who would need arrhythmic risk stratification.</abstract><cop>United States</cop><pub>Lippincott Williams & Wilkins</pub><pmid>27516479</pmid><doi>10.1161/CIRCIMAGING.116.005030</doi><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1941-9651 |
| ispartof | Circulation. Cardiovascular imaging, 2016-08, Vol.9 (8), p.e005030-e005030 |
| issn | 1941-9651 1942-0080 |
| language | eng |
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| source | MEDLINE; EZB Electronic Journals Library; American Heart Association |
| subjects | Adult Arrhythmias, Cardiac - complications Arrhythmias, Cardiac - diagnostic imaging Arrhythmias, Cardiac - mortality Arrhythmias, Cardiac - physiopathology Biopsy Contrast Media - administration & dosage Death, Sudden, Cardiac - etiology Echocardiography Electrocardiography, Ambulatory Female Fibrosis Heart Ventricles - diagnostic imaging Heart Ventricles - physiopathology Humans Hypertrophy, Left Ventricular - diagnostic imaging Hypertrophy, Left Ventricular - etiology Hypertrophy, Left Ventricular - mortality Hypertrophy, Left Ventricular - physiopathology Linear Models Magnetic Resonance Imaging Male Middle Aged Mitral Valve - diagnostic imaging Mitral Valve - physiopathology Mitral Valve Prolapse - diagnostic imaging Mitral Valve Prolapse - etiology Mitral Valve Prolapse - mortality Mitral Valve Prolapse - physiopathology Original Papillary Muscles - diagnostic imaging Papillary Muscles - physiopathology Prognosis Risk Factors Ventricular Function, Left Young Adult |
| title | Morphofunctional Abnormalities of Mitral Annulus and Arrhythmic Mitral Valve Prolapse |
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