Relations of Augmented Systolic Annular Expansion and Leaflet/Papillary Muscle Dynamics in Late-Systolic Mitral Valve Prolapse Evaluated by Echocardiography with a Speckle Tracking Analysis

• Published in: International Heart Journal Vol. 61; no. 5; pp. 970 - 978
• Main Authors: Hei, Soshi, Iwataki, Mai, Jang, Jeong-Yoon, Kuwaki, Hiroshi, Fukuda, Shota, Kim, Yun-Jeong, Toki, Misako, Onoue, Takeshi, Hayashi, Atsushi, Nishino, Shun, Watanabe, Nozomi, Hayashida, Akihiro, Tsuda, Yuki, Araki, Masaru, Nishimura, Yosuke, Song, Jae-Kwan, Yoshida, Kiyoshi, Levine, Robert A., Otsuji, Yutaka
• Format: Journal Article
• Language: English
• Published: Japan International Heart Journal Association 2020; Japan Science and Technology Agency
• Subjects: Aged; Echocardiography; Echocardiography - methods; Female; Humans; Male; Middle Aged; Mitral valve; Mitral Valve - diagnostic imaging; Mitral Valve - physiopathology; Mitral valve prolapse; Mitral Valve Prolapse - diagnostic imaging; Mitral Valve Prolapse - physiopathology; Multivariate analysis; Papillary Muscles - diagnostic imaging; Papillary Muscles - physiopathology; Retrospective Studies; Sudden death; Systole; Valvular heart disease; Valvular heart disease; Sudden death
• ISSN: 1349-2365; 1349-3299
• DOI: 10.1536/ihj.20-236

The mechanism of systolic annular expansion in mitral valve prolapse (MVP) is not clarified. Since annular expansion is systolic outward shift of MV leaflet/chorda tissue complex at superior and outer ends, annular expansion could be related to inward (superior) shift of the complex at another inferior and inner end of the papillary muscle (PM) tip and/or systolic lengthening of the tissue complex, especially MV leaflets.MV annulus systolic expansion, PMs' systolic superior shift, and MV leaflets' systolic lengthening were evaluated by echocardiography with a speckle tracking analysis in 25 normal subjects, 25 subjects with holo-systolic MVP and 20 subjects with late-systolic MVP.PMs' superior shift, MV leaflets' lengthening, MV annular area at the onset of systole and subsequent MV annulus expansion were significantly greater in late-systolic MVP than in holo-systolic MVP (4.6 ± 1.6 versus 1.5 ± 0.7 mm/m2, 2.5 ± 1.4 versus 0.6 ± 2.0 mm/m2, 6.8 ± 2.5 versus 5.7 ± 1.0 cm2/m2 and 1.6 ± 0.8 versus 0.1 ± 0.5 cm2/m2, P < 0.001, respectively). Multivariate analysis identified MV leaflets' lengthening and PMs' superior shift as independent factors associated with MV annular expansion.Conclusions: These results suggest that systolic MV annular expansion in MVP is related to abnormal MV leaflets' lengthening and PMs' superior shift.