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
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 infer...
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| Published in | International Heart Journal Vol. 61; no. 5; pp. 970 - 978 |
|---|---|
| Main Authors | , , , , , , , , , , , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
Japan
International Heart Journal Association
2020
Japan Science and Technology Agency |
| Subjects | |
| Online Access | Get full text |
| ISSN | 1349-2365 1349-3299 |
| DOI | 10.1536/ihj.20-236 |
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| Abstract | 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. |
|---|---|
| AbstractList | 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/m
, 2.5 ± 1.4 versus 0.6 ± 2.0 mm/m
, 6.8 ± 2.5 versus 5.7 ± 1.0 cm
/m
and 1.6 ± 0.8 versus 0.1 ± 0.5 cm
/m
, 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. 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. 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/m 2 , 2.5 ± 1.4 versus 0.6 ± 2.0 mm/m 2 , 6.8 ± 2.5 versus 5.7 ± 1.0 cm 2 /m 2 and 1.6 ± 0.8 versus 0.1 ± 0.5 cm 2 /m 2 , P < 0.001, respectively). Multivariate analysis identified MV leaflets’ lengthening and PMs’ superior shift as independent factors associated with MV annular expansion. |
| Author | Nishimura, Yosuke Iwataki, Mai Tsuda, Yuki Otsuji, Yutaka Onoue, Takeshi Song, Jae-Kwan Kim, Yun-Jeong Hayashi, Atsushi Watanabe, Nozomi Hei, Soshi Toki, Misako Levine, Robert A. Hayashida, Akihiro Kuwaki, Hiroshi Yoshida, Kiyoshi Fukuda, Shota Jang, Jeong-Yoon Nishino, Shun Araki, Masaru |
| AuthorAffiliation | 4 Department of Cardiology, Miyazaki Medical Association Hospital Cardiovascular Center, Miyazaki, Japan 1 Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan 7 Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, USA 3 Department of Clinical Laboratory, The Sakakibara Heart Institute of Okayama, Okayama, Japan 6 Department of Cardiovascular Surgery, University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan 2 Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea 5 Department of Cardiology, The Sakakibara Heart Institute of Okayama, Okayama, Japan |
| AuthorAffiliation_xml | – name: 1 Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan – name: 7 Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, USA – name: 2 Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea – name: 6 Department of Cardiovascular Surgery, University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan – name: 5 Department of Cardiology, The Sakakibara Heart Institute of Okayama, Okayama, Japan – name: 3 Department of Clinical Laboratory, The Sakakibara Heart Institute of Okayama, Okayama, Japan – name: 4 Department of Cardiology, Miyazaki Medical Association Hospital Cardiovascular Center, Miyazaki, Japan |
| Author_xml | – sequence: 1 fullname: Toki, Misako organization: Department of Clinical Laboratory, The Sakakibara Heart Institute of Okayama – sequence: 1 fullname: Araki, Masaru organization: Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine – sequence: 1 fullname: Levine, Robert A. organization: Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School – sequence: 1 fullname: Hayashida, Akihiro organization: Department of Cardiology, The Sakakibara Heart Institute of Okayama – sequence: 1 fullname: Jang, Jeong-Yoon organization: Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine – sequence: 1 fullname: Kuwaki, Hiroshi organization: Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine – sequence: 1 fullname: Otsuji, Yutaka organization: Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine – sequence: 1 fullname: Watanabe, Nozomi organization: Department of Cardiology, Miyazaki Medical Association Hospital Cardiovascular Center – sequence: 1 fullname: Iwataki, Mai organization: Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine – sequence: 1 fullname: Kim, Yun-Jeong organization: Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine – sequence: 1 fullname: Fukuda, Shota organization: Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine – sequence: 1 fullname: Hei, Soshi organization: Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine – sequence: 1 fullname: Nishimura, Yosuke organization: Department of Cardiovascular Surgery, University of Occupational and Environmental Health, School of Medicine – sequence: 1 fullname: Song, Jae-Kwan organization: Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine – sequence: 1 fullname: Tsuda, Yuki organization: Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine – sequence: 1 fullname: Nishino, Shun organization: Department of Cardiology, Miyazaki Medical Association Hospital Cardiovascular Center – sequence: 1 fullname: Onoue, Takeshi organization: Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine – sequence: 1 fullname: Yoshida, Kiyoshi organization: Department of Cardiology, The Sakakibara Heart Institute of Okayama – sequence: 1 fullname: Hayashi, Atsushi organization: Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/32999196$$D View this record in MEDLINE/PubMed |
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| CitedBy_id | crossref_primary_10_1093_europace_euae224 crossref_primary_10_1007_s10489_025_06419_z crossref_primary_10_1161_CIRCIMAGING_122_014963 crossref_primary_10_3389_fcvm_2023_1057986 crossref_primary_10_3390_jcm12031232 |
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| References | 12. He Z, Bhattacharya S. Papillary muscle and annulus size effect on anterior and posterior annulus tension of the mitral valve: an insight into annulus dilatation. J Biomech 2008; 41: 2524-32. 20. Daimon M, Shiota T, Gillinov AM, et al. Percutaneous mitral valve repair for chronic ischemic mitral regurgitation: a real-time three-dimensional echocardiographic study in an ovine model. Circulation 2005; 111: 2183-9. 8. Shi J, Xing Y, Qian J, et al. Early assessment of left ventricular function by layer-specific strain and its relationship to pulsatile arterial load in patients with coronary slow flow. Int Heart J 2019; 60: 586-92. 11. Levine RA, Handschumacher MD, Sanfilippo AJ, et al. Three-dimensional echocardiographic reconstruction of the mitral valve, with implications for the diagnosis of mitral valve prolapse. Circulation 1989; 80: 589-98. 19. Vaidya VR, DeSimone CV, Damle N, et al. Reduction in malignant ventricular arrhythmia and appropriate shocks following surgical correction of bileaflet mitral valve prolapse. J Interv Card Electrophysiol 2016; 46: 137-43. 13. Topilsky Y, Michelena H, Bichara V, Maalouf J, Mahoney DW, Enriquez-Sarano M. Mitral valve prolapse with mid-late systolic mitral regurgitation: pitfalls of evaluation and clinical outcome compared with holosystolic regurgitation. Circulation 2012; 125: 1643-51. 18. Ling LH, Enriquez-Sarano M, Seward JB, et al. Early surgery in patients with mitral regurgitation due to flail leaflets: a long-term outcome study. Circulation 1997; 96: 1819-25. 7. Clark RE. Stress-strain characteristics of fresh and frozen human aortic and mitral leaflets and chordae tendineae. Implications for clinical use. J Thorac Cardiovasc Surg 1973; 66: 202-8. 2. Basso C, Perazzolo Marra M, Rizzo S, et al. Arrhythmic mitral valve prolapse and sudden cardiac death. Circulation 2015; 132: 556-66. 3. Han Y, Peters DC, Salton CJ, et al. Cardiovascular magnetic resonance characterization of mitral valve prolapse. JACC Cardiovasc Imaging 2008; 1: 294-303. 9. Noack T, Kiefer P, Mallon L, et al. Changes in dynamic mitral valve geometry during percutaneous edge-edge mitral valve repair with the MitraClip system. J Echocardiogr 2019; 17: 84-94. 10. Ji Q, Zhao Y, Shen JQ, et al. Risk factors for moderate or more residual regurgitation in patients with moderate chronic ischemic mitral regurgitation undergoing surgical revascularization alone. Int Heart J 2019; 60: 1268-75. 22. Feldman T, Kar S, Elmariah S, et al. Randomized comparison of percutaneous repair and surgery for mitral regurgitation: 5-year results of EVEREST II. J Am Coll Cardiol 2015; 66: 2844-54. 15. Otani K, Takeuchi M, Kaku K, et al. Evidence of a vicious cycle in mitral regurgitation with prolapse: secondary tethering attributed to primary prolapse demonstrated by three-dimensional echocardiography exacerbates regurgitation. Circulation 2012; 126 (Suppl 1): S214-21. 24. Sriram CS, Syed FF, Ferguson ME, et al. Malignant bileaflet mitral valve prolapse syndrome in patients with otherwise idiopathic out-of-hospital cardiac arrest. J Am Coll Cardiol 2013; 62: 222-30. 4. Chesler E, King RA, Edwards JE. The myxomatous mitral valve and sudden death. Circulation 1983; 67: 632-9. 21. De Bonis M, Lapenna E, Maisano F, et al. Long-term results (≤18 years) of the edge-to-edge mitral valve repair without annuloplasty in degenerative mitral regurgitation: implications for the percutaneous approach. Circulation 2014; 130 (Suppl 1): S19-24. 14. Otsuji Y, Handschumacher MD, Schwammenthal E, et al. Insights from three-dimensional echocardiography into the mechanism of functional mitral regurgitation: direct in vivo demonstration of altered leaflet tethering geometry. Circulation 1997; 96: 1999-2008. 5. Sanfilippo AJ, Harrigan P, Popovic AD, Weyman AE, Levine RA. Papillary muscle traction in mitral valve prolapse: quantitation by two-dimensional echocardiography. J Am Coll Cardiol 1992; 19: 564-71. 23. Gornick CC, Tobler HG, Pritzker MC, Tuna IC, Almquist A, Benditt DG. Electrophysiologic effects of papillary muscle traction in the intact heart. Circulation 1986; 73: 1013-21. 6. Hei S, Iwataki M, Jang JY, et al. Possible mechanism of late-systolic mitral valve prolapse: systolic superior shift of leaflets secondary to annular dilatation that causes papillary muscle traction. Am J Physiol Heart Circ Physiol 2019; 316: H629-38. 17. Levine RA, Hagége AA, Judge DP, et al. Mitral valve disease: morphology and mechanisms. Nat Rev Cardiol 2015; 12: 689-710. 1. Clavel MA, Mantovani F, Malouf J, et al. Dynamic phenotypes of degenerative myxomatous mitral valve disease: quantitative 3-dimensional echocardiographic study. Circ Cardiovasc Imaging 2015; 8: e002989. 16. Fukuda S, Song JK, Mahara K, et al. Basal left ventricular dilatation and reduced contraction in patients with mitral valve prolapse can be secondary to annular dilatation: preoperative and postoperative speckle-tracking echocardiographic study on left ventricle and mitral valve annulus interaction. Circ Cardiovasc Imaging 2016; 9: e005113. 11 22 12 23 13 24 14 15 16 17 18 19 1 2 3 4 5 6 7 8 9 20 10 21 |
| References_xml | – reference: 2. Basso C, Perazzolo Marra M, Rizzo S, et al. Arrhythmic mitral valve prolapse and sudden cardiac death. Circulation 2015; 132: 556-66. – reference: 22. Feldman T, Kar S, Elmariah S, et al. Randomized comparison of percutaneous repair and surgery for mitral regurgitation: 5-year results of EVEREST II. J Am Coll Cardiol 2015; 66: 2844-54. – reference: 14. Otsuji Y, Handschumacher MD, Schwammenthal E, et al. Insights from three-dimensional echocardiography into the mechanism of functional mitral regurgitation: direct in vivo demonstration of altered leaflet tethering geometry. Circulation 1997; 96: 1999-2008. – reference: 24. Sriram CS, Syed FF, Ferguson ME, et al. Malignant bileaflet mitral valve prolapse syndrome in patients with otherwise idiopathic out-of-hospital cardiac arrest. J Am Coll Cardiol 2013; 62: 222-30. – reference: 23. Gornick CC, Tobler HG, Pritzker MC, Tuna IC, Almquist A, Benditt DG. Electrophysiologic effects of papillary muscle traction in the intact heart. Circulation 1986; 73: 1013-21. – reference: 19. Vaidya VR, DeSimone CV, Damle N, et al. Reduction in malignant ventricular arrhythmia and appropriate shocks following surgical correction of bileaflet mitral valve prolapse. J Interv Card Electrophysiol 2016; 46: 137-43. – reference: 5. Sanfilippo AJ, Harrigan P, Popovic AD, Weyman AE, Levine RA. Papillary muscle traction in mitral valve prolapse: quantitation by two-dimensional echocardiography. J Am Coll Cardiol 1992; 19: 564-71. – reference: 18. Ling LH, Enriquez-Sarano M, Seward JB, et al. Early surgery in patients with mitral regurgitation due to flail leaflets: a long-term outcome study. Circulation 1997; 96: 1819-25. – reference: 6. Hei S, Iwataki M, Jang JY, et al. Possible mechanism of late-systolic mitral valve prolapse: systolic superior shift of leaflets secondary to annular dilatation that causes papillary muscle traction. Am J Physiol Heart Circ Physiol 2019; 316: H629-38. – reference: 1. Clavel MA, Mantovani F, Malouf J, et al. Dynamic phenotypes of degenerative myxomatous mitral valve disease: quantitative 3-dimensional echocardiographic study. Circ Cardiovasc Imaging 2015; 8: e002989. – reference: 10. Ji Q, Zhao Y, Shen JQ, et al. Risk factors for moderate or more residual regurgitation in patients with moderate chronic ischemic mitral regurgitation undergoing surgical revascularization alone. Int Heart J 2019; 60: 1268-75. – reference: 8. Shi J, Xing Y, Qian J, et al. Early assessment of left ventricular function by layer-specific strain and its relationship to pulsatile arterial load in patients with coronary slow flow. Int Heart J 2019; 60: 586-92. – reference: 11. Levine RA, Handschumacher MD, Sanfilippo AJ, et al. Three-dimensional echocardiographic reconstruction of the mitral valve, with implications for the diagnosis of mitral valve prolapse. Circulation 1989; 80: 589-98. – reference: 17. Levine RA, Hagége AA, Judge DP, et al. Mitral valve disease: morphology and mechanisms. Nat Rev Cardiol 2015; 12: 689-710. – reference: 3. Han Y, Peters DC, Salton CJ, et al. Cardiovascular magnetic resonance characterization of mitral valve prolapse. JACC Cardiovasc Imaging 2008; 1: 294-303. – reference: 16. Fukuda S, Song JK, Mahara K, et al. Basal left ventricular dilatation and reduced contraction in patients with mitral valve prolapse can be secondary to annular dilatation: preoperative and postoperative speckle-tracking echocardiographic study on left ventricle and mitral valve annulus interaction. Circ Cardiovasc Imaging 2016; 9: e005113. – reference: 15. Otani K, Takeuchi M, Kaku K, et al. Evidence of a vicious cycle in mitral regurgitation with prolapse: secondary tethering attributed to primary prolapse demonstrated by three-dimensional echocardiography exacerbates regurgitation. Circulation 2012; 126 (Suppl 1): S214-21. – reference: 9. Noack T, Kiefer P, Mallon L, et al. Changes in dynamic mitral valve geometry during percutaneous edge-edge mitral valve repair with the MitraClip system. J Echocardiogr 2019; 17: 84-94. – reference: 4. Chesler E, King RA, Edwards JE. The myxomatous mitral valve and sudden death. Circulation 1983; 67: 632-9. – reference: 20. Daimon M, Shiota T, Gillinov AM, et al. Percutaneous mitral valve repair for chronic ischemic mitral regurgitation: a real-time three-dimensional echocardiographic study in an ovine model. Circulation 2005; 111: 2183-9. – reference: 21. De Bonis M, Lapenna E, Maisano F, et al. Long-term results (≤18 years) of the edge-to-edge mitral valve repair without annuloplasty in degenerative mitral regurgitation: implications for the percutaneous approach. Circulation 2014; 130 (Suppl 1): S19-24. – reference: 13. Topilsky Y, Michelena H, Bichara V, Maalouf J, Mahoney DW, Enriquez-Sarano M. Mitral valve prolapse with mid-late systolic mitral regurgitation: pitfalls of evaluation and clinical outcome compared with holosystolic regurgitation. Circulation 2012; 125: 1643-51. – reference: 7. Clark RE. Stress-strain characteristics of fresh and frozen human aortic and mitral leaflets and chordae tendineae. Implications for clinical use. J Thorac Cardiovasc Surg 1973; 66: 202-8. – reference: 12. He Z, Bhattacharya S. Papillary muscle and annulus size effect on anterior and posterior annulus tension of the mitral valve: an insight into annulus dilatation. 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| Snippet | The mechanism of systolic annular expansion in mitral valve prolapse (MVP) is not clarified. Since annular expansion is systolic outward shift of MV... |
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| SubjectTerms | 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 |
| Title | 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 |
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