Quantitative analysis of mitral annular geometry and function in healthy volunteers using transthoracic three-dimensional echocardiography

Sorina Mihăilă; Denisa Muraru; Eleonora Piasentini; Marcelo Haertel Miglioranza; Diletta Peluso; Umberto Cucchini; Sabino Iliceto; Dragoş Vinereanu; Luigi P Badano

doi:10.1016/j.echo.2014.04.017

Quantitative analysis of mitral annular geometry and function in healthy volunteers using transthoracic three-dimensional echocardiography

J Am Soc Echocardiogr. 2014 Aug;27(8):846-57. doi: 10.1016/j.echo.2014.04.017. Epub 2014 Jun 2.

Authors

Sorina Mihăilă¹, Denisa Muraru², Eleonora Piasentini², Marcelo Haertel Miglioranza³, Diletta Peluso², Umberto Cucchini², Sabino Iliceto², Dragoş Vinereanu⁴, Luigi P Badano⁵

Affiliations

¹ Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy; University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania.
² Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy.
³ Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy; Cardiology Institute of Rio Grande do Sul, Porto Alegre, Brazil.
⁴ University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania.
⁵ Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy. Electronic address: lpbadano@gmail.com.

PMID: 24891260
DOI: 10.1016/j.echo.2014.04.017

Abstract

Background: Quantitative assessment of the mitral annulus provides information regarding the pathophysiology of mitral regurgitation and aids in the planning of reparative surgery. Three-dimensional (3D) transthoracic echocardiographic data sets acquired with current scanners have enough spatial and temporal resolution to allow the quantitative analysis of the mitral annulus. Accordingly, the authors performed (1) a validation study to assess the agreement of quantitative analysis of the mitral annulus performed on 3D transthoracic echocardiography (TTE) and 3D transesophageal echocardiography (TEE) and (2) a normative study to obtain the reference values of 3D transthoracic echocardiographic parameters for mitral annular (MA) geometry and dynamics.

Methods: Mitral valve data sets were obtained by 3D TEE and 3D TTE in 30 consecutive patients with clinically indicated TEE (validation study) and 3D TTE in 224 healthy volunteers (aged 18-76 years) (normative study).

Results: In the validation study, MA measurements obtained by 3D TTE were similar to those obtained by 3D TEE (P = NS). In the normative study, MA analysis by 3D TTE was feasible (94.5%) and reproducible (intraclass correlation coefficient = 0.78-0.97). MA diameters, area, and circumference were correlated with body surface area (r > 0.50 for all) but not with age. Men had larger MA areas than women (4.9 ± 1.0 vs 4.5 ± 0.7 cm(2)/m(2), P = .004). During systole, MA area decreased by 29 ± 5%. This decrease was related mainly to anteroposterior diameter shortening (20 ± 7%).

Conclusions: MA quantitative analysis by 3D TTE was accurate compared with 3D TEE in unselected patients with mitral valve disease. In healthy subjects, it was highly feasible and reproducible. The availability of reference values for MA geometry and dynamics may foster the implementation of MA quantitative analysis by 3D TTE in clinical settings.

Keywords: Mitral annulus; Mitral valve; Normal subjects; Reference values; Three-dimensional echocardiography; Transesophageal echocardiography; Transthoracic echocardiography.

Publication types

Validation Study

MeSH terms

Adolescent
Adult
Aged
Echocardiography, Three-Dimensional / methods*
Echocardiography, Transesophageal / methods*
Female
Healthy Volunteers
Humans
Male
Middle Aged
Mitral Valve / diagnostic imaging*
Mitral Valve Insufficiency / diagnostic imaging*
ROC Curve
Reproducibility of Results
Retrospective Studies
Young Adult