Mitral Annular Dimensions and Geometry in Patients With Functional Mitral Regurgitation and Mitral Valve Prolapse: Implications for Transcatheter Mitral Valve Implantation

详细信息    查看全文

• 作者：Christopher Naoum ; MBBS^a ; Jonathon Leipsic ; MD^a ; Anson Cheung ; MD^a ; Jian Ye ; MD^a ; Nicolas Bilbey ; MD^a ; George Mak ; MBBS^a ; Adam Berger ; MBBS^a ; Danny Dvir ; MD^a ; Chesnal Arepalli ; MD^a ; Jasmine Grewal ; MD^a ; David Muller ; MBBS^b ; Darra Murphy ; MBBS^a ; Cameron Hague ; MD^a ; Nicolo Piazza ; MD^c ; John Webb ; MD^a ; Philipp Blanke ; MD^a ; ^{phil.blanke@googlemail.com" class="auth_mail" title="E-mail the corresponding author}
• 关键词：computed tomography ; mitral annulus ; mitral regurgitation ; TMVI ; TMVR ; transcatheter mitral valve implantation
• 刊名：JACC: Cardiovascular Imaging
• 出版年：2016
• 出版时间：March 2016
• 年：2016
• 卷：9
• 期：3
• 页码：269-280
• 全文大小：1184 K

文摘

The aims of this study were to determine D-shaped mitral annulus (MA) dimensions in control subjects without significant cardiac disease and in patients with moderate to severe mitral regurgitation (MR) being considered for transcatheter mitral therapy and to determine predictors of annular size, using cardiac computed tomography.

Background

The recently introduced D-shaped method of MA segmentation represents a biomechanically appropriate approach for annular sizing prior to transcatheter mitral valve implantation.

Methods

Patients who had retrospectively gated cardiac computed tomography performed at our institution (2012 to 2014) and were free of significant cardiac disease were included as controls (n = 88; 56 ± 11 years of age; 47% female) and were compared with patients with moderate or severe MR due to functional mitral regurgitation (FMR) (n = 27) or mitral valve prolapse (MVP) (n = 32). MA dimensions (projected area, perimeter, intercommissural, and septal-to-lateral distance), maximal left atrial (LA) volumes, and phasic left ventricular volumes were measured.

Results

MA dimensions were larger in patients with FMR or MVP compared with controls (area index 4.7 ± 0.6 cm²/m², 6.0 ± 1.3 cm²/m², and 7.3 ± 1.7 cm²/m²; perimeter index 59 ± 5 mm/m², 67 ± 9 mm/m², and 75 ± 10 mm/m²; intercommissural distance index 20.2 ± 1.9 mm/m², 21.2 ± 3.1 mm/m², and 24.7 ± 3.2 mm/m²; septal-to-lateral distance index 14.8 ± 1.6, 18.1 ± 3.3, and 19.5 ± 3.4 mm/m² in controls and patients with FMR and MVP, respectively; p < 0.05 between controls and MR subgroups). Absolute MA area was 18% larger in patients with MVP than patients with FMR (13.0 ± 2.9 cm² vs. 11.0 ± 2.3 cm²; p = 0.006). Although LA and left ventricular volumes were both independently associated with MA area index in controls and patients with MVP, only LA volume was associated with annular size in patients with FMR.

Conclusions

Moderate to severe MR was associated with increased MA dimensions, especially among patients with MVP compared with control subjects without cardiac disease. Moreover, unlike in controls and patients with MVP, annular enlargement in FMR was more closely associated with LA dilation.