Background
Methods
Study population
Mitral valve analysis software package validation
Echocardiography and quantitative image analysis
Statistical analysis
Results
Validation study
Transthoracic N = 15 | Transoesophageal N = 15 |
p
|
r
| |
---|---|---|---|---|
Diastolic dimension | ||||
Annulus area (3D) (cm2) | 11.5 ± 3.1 | 12.4 ± 3.2 | 0.031 | 0.879** |
Annulus best fit plane (cm2) | 10.6 ± 3.0 | 11.7 ± 3.1 | 0.016 | 0.869** |
Annulus perimeter (cm) | 12.1 ± 1.7 | 12.6 ± 1.6 | 0.036 | 0.883** |
AP diameter (cm) | 3.5 ± 0.5 | 3.8 ± 0.5 | 0.012 | 0.799** |
ALPM diameter (cm) | 3.7 ± 0.5 | 3.8 ± 0.5 | 0.342 | 0.840** |
Commissural diameter (cm) | 3.7 ± 0.4 | 3.8 ± 0.5 | 0.231 | 0.777** |
Itertrigonal distance (cm) | 2.8 ± 0.3 | 3.0 ± 0.4 | 0.094 | 0.715** |
Sphericity index | 0.9 ± 0.1 | 1.0 ± 0.1 | 0.150 | 0.157 |
Annulus height (mm) | 7.3 ± 1.7 | 6.8 ± 1.6 | 0.343 | 0.559* |
Non planar angle | 156 ± 13 | 152 ± 11 | 0.314 | 0.474 |
Mitro-aortic angle | 131 ± 8 | 125 ± 10 | 0.039 | 0.418 |
Systolic dimension | ||||
Annulus area (3D) (cm2) | 10.2 ± 2.6 | 11.0 ± 2.6 | 0.006 | 0.936** |
Annulus best fit plane (cm2) | 9.3 ± 2.5 | 10.2 ± 2.5 | 0.001 | 0.959** |
Annulus perimeter (cm) | 11.4 ± 1.5 | 11.8 ± 1.4 | 0.010 | 0.943** |
AP diameter (cm) | 3.2 ± 0.4 | 3.4 ± 0.6 | 0.002 | 0.624* ρ |
ALPM diameter (cm) | 3.6 ± 0.5 | 3.6 ± 0.4 | 0.329 | 0.857** |
Commissural diameter (cm) | 3.5 ± 0.4 | 3.6 ± 0.4 | 0.151 | 0.889** |
Itertrigonal distance (cm) | 2.6 ± 0.4 | 3.0 ± 0.4 | 0.000 | 0.830** |
Sphericity index | 0.9 ± 0.1 | 0.9 ± 0.1 | 0.062 | 0.321ρ |
Annulus height (mm) | 7.0 ± 1.3 | 7.0 ± 1.4 | 0.910 | 0.300 |
Non planar angle (°) | 153 ± 10 | 153 ± 9 | 0.893 | 0.240 |
Aorto-mitral angle (°) | 139 ± 10 | 129 ± 8 | 0.005 | 0.367 |
Tenting height (mm) | 10.3 ± 2.0 | 7.2 ± 3.6 | 0.02 | - 0.108 |
Tenting area (cm2) | 2.3 ± 0.6 | 2.3 ± 0.7 | 0.934 | 0.542* |
Tenting volume (mL) | 4.2 ± 1.3 | 4.1 ± 1.5 | 0.742 | 0.747** |
Comparison of mitral annulus geometry between ischemic and non-ischemic mitral regurgitation
Ischemic mitral regurgitation N = 41 | Non ischemic mitral regurgitation N = 53 |
p
| |
---|---|---|---|
Age (years) | 69 (63–75) | 64 (55–72) | 0.081 |
Men (%) |
35 (85)
|
35 (66)
|
0.033
|
Body surface area (m 2 ) | 1.8 (1.7–1.9) | 1.9 (1.7–2.0) | 0.374 |
Heart rate (bpm) | 71 (59–85) | 75 (65–86) | 0.237 |
Systolic blood pressure (mmHg) | 110 (100–120) | 100 (95–115) | 0.340 |
Diastolic blood pressure(mmHg) | 65 (60–71) | 65 (60–70) | 0.233 |
Hypertension |
32 (80%)
|
25 (48.1%)
|
0.002
|
Diabetes |
15 (37.5%)
|
8 (15.4%)
|
0.015
|
Dyslipidemia |
30 (75%)
|
22 (42.3%)
|
0.002
|
Smokers | 23 (57.5%) | 24 (46.2%) | 0.280 |
Resynchronization therapy | 8 (20%) | 17 (32.7%) | 0.175 |
Ischemic mitral regurgitation N = 41 | Non ischemic mitral regurgitation N = 53 |
p
| |
---|---|---|---|
MR Vena contracta (mm) | 7 (6–8) | 7 (6–8) | 0.658 |
MR PISA radius (mm) | 7 (6–8) | 8 (7–9) | 0.138 |
MR EROA (mm2) | 2 (2–3) | 2.1(2–3) | 0.421 |
MR R Vol (mL) | 38 (28–58) | 38.5 (29–47.7) | 0.803 |
sPAP | 47 (35–56) | 44 (35–49) | 0.211 |
TR severity | Trivial 6 (11.3%) | Trivial 6 (15.4%) | 0.753 |
Mild 29 (54.7%) | Mild 20 (51.3%) | ||
Moderate11 (20.8%) | Moderate10 (25.6%) | ||
Severe 7 (13.2%) | Severe3 (7.7%) | ||
AR severity | None 25 (49%) | None 25 (65%) | 0.437 |
Trivial 13 (25%) | Trivial 6 (15%) | ||
Mild 12 (23.5%) | Mild 9 (22.5%) | ||
Moderate 1 (2%) | Moderate 0 (0%) | ||
LV EDV (ml/m2) | 134 (114–153) | 143 (116–178) | 0.078 |
LV ESV (mL/m2) | 96 (68–109) | 105 (78–135) | 0.075 |
Ejection Fraction (%) |
31 (26–38)
|
28 (22–32)
|
0.030
|
Indexed LA volume (mL/m2) |
60 (51–68)
|
70 (53–91)
|
0.031
|
Ischemic mitral regurgitation N = 41 | Non ischemic mitral regurgitation N = 53 |
p
| |
---|---|---|---|
Diastolic dimension | |||
Annulus area (3D) (cm2) | 10.7 ± 2.5a | 11.6 ± 2.7a | 0.124 |
Annulus best fit plane (cm2) | 9.9 ± 2.3a | 10.7 ± 2.5a | 0.135 |
Annulus perimeter (cm) | 11.7 ± 1.4a | 12.2 ± 1.4a | 0.111 |
AP diameter (cm) | 3.3 ± 0.4a | 3.5 ± 0.5a | 0.072 |
ALPM diameter (cm) | 3.6 ± 0.4a | 3.8 ± 0.5a | 0.129 |
Commissural diameter(cm) | 3.6 ± 0.4 | 3.7 ± 0.4 | 0.300 |
Itertrigonal distance (cm) | 2.7 ± 0.4a | 2.8 ± 0.3a | 0.374 |
Annulus height (mm) | 6.3 ± 1.7a | 6.8 ± 1.7a | 0.144 |
Sphericity index | 0.9 ± 0.1a | 0.9 ± 0.1a | 0.963 |
Non planar angle (°) | 156 ± 11a | 153 ± 10a | 0.232 |
Anterior leaflet area (cm2) | 7.5 ± 1.6a | 8.0 ± 1.6a | 0.142 |
Posterior leaflet area (cm2) | 7.2 ± 2.3a | 7.5 ± 2.1a | 0.413 |
Anterior leaflet length (cm) | 2.9 ± 0.4 | 3.3 ± 0.9a | 0.102 |
Posterior leaflet length (cm) | 1.6 ± 0.4a | 1.7 ± 0.6a | 0.319 |
Aorto-mitral angle (°) | 131 ± 9a | 135 ± 11a | 0.115 |
Systolic dimension | |||
Annulus area (3D) (cm2) |
9.8 ± 2.3
|
10.8 ± 2.7
|
0.046
|
Annulus best fit plane (cm2) | 9 ± 2.1 | 9.9 ± 2.5 | 0.063 |
Annulus perimeter (cm) |
11.2 ± 1.3
|
11.8 ± 1.5
|
0.048
|
AP diameter (cm) | 3.1 ± 0.4 | 3.2 ± 0.5 | 0.063 |
ALPM diameter (cm) | 3.5 ± 0.4 | 3.7 ± 0.5 | 0.065 |
Commissural diameter(cm) | 3.5 ± 0.4 | 3.7 ± 0.4 | 0.130 |
Itertrigonal distance (cm) | 2.5 ± 0.3 | 2.7 ± 0.3 | 0.051 |
Annulus height (mm) |
6.7 ± 1.6
|
7.5 ± 1.9
|
0.047
|
Sphericity index | 0.9 ± 0.08 | 0.9 ± 0.1 | 0.598 |
Non planar angle (°) | 153 ± 11 | 150 ± 10 | 0.268 |
Anterior leaflet area (cm2) |
6.5 ± 1.6
|
7.4 ± 1.7
|
0.006
|
Posterior leaflet area (cm2) |
5.7 ± 1.7
|
6.5 ± 1.9
|
0.049
|
Anterior leaflet length (cm) |
2.8 ± 0.6
|
3 ± 0.4
|
0.022
|
Posterior leaflet length (cm) |
1.3 ± 0.4
|
1.5 ± 0.8
|
0.022
|
Aorto-mitral angle (°) |
135 ± 10
|
141 ± 11
|
0.011
|
Tenting height (mm) | 9.3 ± 2.6 | 10.3 ± 2.8 | 0.082 |
Tenting area (cm2) | 2.2 ± 0.7 | 2.4 ± 0.8 | 0.141 |
Tenting volume (mL) |
4 ± 1.7
|
4.7 ± 1.7
|
0.047
|
Mitral annulus dynamics
Ischemic mitral regurgitation N = 41 | Non ischemic mitral regurgitation N = 53 |
p
| |
---|---|---|---|
MA area (3D) fraction (%) | -6 (-11.7 — -1.8) | -4.3 ( -9.8 — -1.3) | > 0.05 |
MA best fit plane fraction (%) | -6.3 (-13 — -4) | -6.7 (-11.4 — -1.8) | > 0.05 |
MA perimeter fraction (%) | -3.2 (-5.8 — -0.4) | -2.1 (-4.6 — -0.8) | > 0.05 |
AP diameter fraction (%) | -7.4 (-11.4 — -2.4) | -5.9 (-11.2 — -1.3) | > 0.05 |
ALPM diameter fraction (%) | -2.9 (-6.9 — 0.0) | 0.0 (-7.3 — 0.0) | > 0.05 |
CC diameter fraction (%) | -2.6 (-5.5 — 2.9) | 0.0 (-4.7 — 2.7) | > 0.05 |
TT distance fraction (%) | -4.8 (-12.4 — 0.0) | -3.1 (-10 — 3.8) | > 0.05 |
Non planar angle fraction (%) | -2 (-6.3 — 2.5) | -2.4 (-5.6 — 2) | > 0.05 |
Aorto-mitral angle fraction (%) | 3.7 (-2.5 — 8.4) | 3.4 (0–8.4) | > 0.05 |