Mitral Annular Dynamics in Mitral Annular Calcification: A Three-Dimensional Imaging Study - 01/07/15
, Rajesh Movva, MD a, Yan Topilsky, MD b, Marie-Annick Clavel, DVM, MSc b, Jason A. Saldanha, BSc c, Nozomi Watanabe, MD d, Maurice Enriquez-Sarano, MD bAbstract |
Background |
The mitral annulus displays complex conformational changes during the cardiac cycle that can now be quantified by three-dimensional echocardiography. Mitral annular calcification (MAC) is increasingly encountered, but its structural and dynamic consequences are largely unexplored. The objective of this study was to describe alterations in mitral annular dimensions and dynamics in patients with MAC.
Methods |
Transthoracic three-dimensional echocardiography was performed in 43 subjects with MAC and 36 age- and sex-matched normal control subjects. Mitral annular dimensions were quantified, using dedicated software, at six time points (three diastolic, three systolic) during the cardiac cycle.
Results |
In diastole, the calcified annulus was larger and flatter than normal, with increased anteroposterior diameter (29.4 ± 0.6 vs 27.8 ± 0.6 mm, P = .046), reduced height (2.8 ± 0.2 vs 3.6 ± 0.2 mm, P = .006), and decreased saddle shape (8.9 ± 0.6% vs 11.4 ± 0.6%, P = .005). In systole, patients with MAC had greater annular area at all time points (P < .05 for each) compared with control subjects, because of reduced contraction along the anteroposterior diameter (P < .001). Saddle shape increased in early systole (from 10.5% to 13.5%, P = .04) in control subjects but not in those with MAC (P = NS). Valvular alterations were also noted; although mitral valve tent length decreased during systole in both groups, decreases were less in patients with MAC (P < .05 for mid- and late systole). For certain parameters (e.g., annular area), changes were confined largely to those patients with moderate to severe MAC (P = .006 vs control subjects, but nonsignificant for patients with mild MAC).
Conclusions |
Quantitative three-dimensional echocardiography provides new insights into the dynamic consequences of MAC. This imaging technique demonstrates that the mitral annulus is not made smaller by calcification. However, there is loss of annular contraction, particularly along the anteroposterior diameter, and loss of early systolic folding along the intercommissural diameter. Associated valvular alterations include smaller than usual declines in tenting during systole. These quantitative three-dimensional echocardiographic data provide new insights into the dynamic physiology of the calcified mitral annulus.
Le texte complet de cet article est disponible en PDF.Highlights |
• | The calcified mitral annulus is larger and flatter than normal. |
• | There is decreased annular contraction and systolic saddle deepening. |
• | There is increased systolic tenting of the met with the aortic root and iflets. |
Keywords : Mitral annular dynamics, Mitral annular calcification, Three-dimensional echocardiography
Abbreviations : AP, IC, MAC, 3D, 3DE
Plan
| This work was supported by a grant from the Albert Einstein Society (Philadelphia, PA). The authors report that they have no relationships relevant to the contents of this report to disclose. |
Vol 28 - N° 7
P. 786-794 - juillet 2015 Retour au numéro
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