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Morphofunctional abnormalities of mitral annulus and arrhythmic mitral valve prolapse
- Publication Year :
- 2016
- Publisher :
- Lippincott Williams and Wilkins, 2016.
-
Abstract
- Background— 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. Methods and Results— 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 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 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 Conclusions— 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.
- Subjects :
- Male
mitral valve
Biopsy
Contrast Media
030204 cardiovascular system & hematology
Ventricular Function, Left
0302 clinical medicine
Fibrosis
Risk Factors
Mitral valve
Nuclear Medicine and Imaging
Medicine
Mitral valve prolapse
030212 general & internal medicine
Middle Aged
Prognosis
Magnetic Resonance Imaging
medicine.anatomical_structure
Echocardiography
cardiovascular system
Cardiology
Female
Hypertrophy, Left Ventricular
Cardiology and Cardiovascular Medicine
Radiology
Adult
medicine.medical_specialty
Heart Ventricles
Sudden death
03 medical and health sciences
Young Adult
gadolinium
mitral valve annulus
mitral valve prolapse
papillary muscles
Radiology, Nuclear Medicine and Imaging
Internal medicine
Humans
Radiology, Nuclear Medicine and imaging
Mitral Valve Annulus
cardiovascular diseases
Mitral annulus
Midsystolic click
Mitral regurgitation
business.industry
Arrhythmias, Cardiac
medicine.disease
Death, Sudden, Cardiac
Electrocardiography, Ambulatory
Linear Models
business
Subjects
Details
- Language :
- English
- Database :
- OpenAIRE
- Accession number :
- edsair.doi.dedup.....3bb37aa01d4f467dc073f5433a490307