Three-Dimensional Transthoracic Static and Dynamic Normative Values of the Mitral Valve Apparatus: Results from the Multicenter World Alliance Societies of Echocardiography Study

Overview

Journal J Am Soc Echocardiogr

Specialty Radiology

Date 2022 Mar 4

PMID 35245668

Authors

Michael P Henry

Juan Cotella

Victor Mor-Avi

Karima Addetia

Tatsuya Miyoshi

Marcus Schreckenberg

Michael Blankenhagen

Niklas Hitschrich

Vivekanandan Amuthan

Rodolfo Citro

Masao Daimon

Pedro Gutierrez-Fajardo

Ravi Kasliwal

James N Kirkpatrick

Mark J Monaghan

Denisa Muraru

Kofo O Ogunyankin

Seung Woo Park

Ana Clara Tude Rodrigues

Ricardo Ronderos

Anita Sadeghpour

Gregory Scalia

Masaaki Takeuchi

Wendy Tsang

Edwin S Tucay

Mei Zhang

Roberto M Lang

Federico M Asch

Affiliations

Soon will be listed here.

Abstract

Background: Recent advances in mitral valve (MV) percutaneous interventions have escalated the need for a more quantitative and comprehensive assessment of the MV, which can be best achieved using three-dimensional echocardiography. Understanding normal valve size, structure, and function is essential for differentiation of healthy from disease states. The aims of this study were to establish normative values for MV apparatus size and morphology and to determine how they vary across age, sex, and race groups using data from the World Alliance Societies of Echocardiography Normal Values Study.

Methods: Three-dimensional volumetric data sets obtained on transthoracic echocardiography in 748 normal subjects (51% men) were analyzed using commercial MV analysis software (TomTec Imaging Systems) to determine annular and leaflet dimensions and areas. The subjects were divided into groups by sex (378 men and 370 women) and age (18 to 40 years [n = 266], 41 to 65 years [n = 249], and >65 years [n = 233]) to identify sex- and age-related differences. In addition, differences among black, white, and Asian populations were studied. Inter- and intraobserver variability was assessed in a subset of 30 subjects and expressed as mean absolute difference between pairs of repeated measurements.

Results: Compared with women, men had larger annular size measurements, larger tenting size parameters, and larger leaflet length and area. Compared with the black and white populations, the Asian population showed significantly smaller mitral annular size. Although many of the age, sex, and race differences in MV parameters were statistically significant, they were comparable with or smaller than the corresponding measurement variability. Indexing to body surface area and height did not eliminate these differences consistently, suggesting that parameters may need to be indexed according to their dimensionality.

Conclusions: This analysis of the World Alliance Societies of Echocardiography data provides normative values of mitral apparatus size and morphology. Although sex- and age-related differences were noted, they need to be interpreted with caution in view of the associated measurement variability.

Citing Articles

Mitral Regurgitation in Female Patients: Sex Differences and Disparities.

Ocher R, May M, Labin J, Shah J, Horwich T, Watson K J Soc Cardiovasc Angiogr Interv. 2024; 2(4):101032.

PMID: 39131652 PMC: 11308238. DOI: 10.1016/j.jscai.2023.101032.

Distinct leaflet-annular remodeling pattern in severe atrial functional mitral regurgitation: a three-dimensional echocardiography study.

Abdelgawad H, Mowafy B, Khidr K, Elsharkawy E Egypt Heart J. 2024; 76(1):77.

PMID: 38913258 PMC: 11196451. DOI: 10.1186/s43044-024-00509-y.

Alcohol septal ablation for hypertrophic obstructive cardiomyopathy: do mitral valve leaflet length, septal thickness, or sex affect the outcome?.

Mustafic M, Jander R, Marlevi D, Rickenlund A, Ruck A, Saleh N Cardiovasc Interv Ther. 2024; 39(4):479-489.

PMID: 38807005 PMC: 11436449. DOI: 10.1007/s12928-024-01014-4.

Dynamic assessment of the tricuspid annulus in a healthy Asian population: A four-dimensional echocardiography study.

Wu J, Huang X, Huang K, Tian Y, Gao Q, Lin B Echocardiography. 2023; 40(2):113-127.

PMID: 36647764 PMC: 10107205. DOI: 10.1111/echo.15528.

A case report of transcatheter repair of severe functional mitral regurgitation in cardiac amyloidosis.

Fangmin M, Shaohua L, Lai W, Cuizhen P Eur Heart J Case Rep. 2022; 7(1):ytac471.

PMID: 36582592 PMC: 9792274. DOI: 10.1093/ehjcr/ytac471.

References

Pai R, Tanimoto M, Jintapakorn W, Azevedo J, Pandian N, Shah P . Volume-rendered three-dimensional dynamic anatomy of the mitral annulus using a transesophageal echocardiographic technique. J Heart Valve Dis. 1995; 4(6):623-7. View

Lang R, Badano L, Tsang W, Adams D, Agricola E, Buck T . EAE/ASE recommendations for image acquisition and display using three-dimensional echocardiography. J Am Soc Echocardiogr. 2011; 25(1):3-46. DOI: 10.1016/j.echo.2011.11.010. View

Asch F, Miyoshi T, Addetia K, Citro R, Daimon M, Desale S . Similarities and Differences in Left Ventricular Size and Function among Races and Nationalities: Results of the World Alliance Societies of Echocardiography Normal Values Study. J Am Soc Echocardiogr. 2019; 32(11):1396-1406.e2. DOI: 10.1016/j.echo.2019.08.012. View

Caiani E, Fusini L, Veronesi F, Tamborini G, Maffessanti F, Gripari P . Quantification of mitral annulus dynamic morphology in patients with mitral valve prolapse undergoing repair and annuloplasty during a 6-month follow-up. Eur J Echocardiogr. 2011; 12(5):375-83. DOI: 10.1093/ejechocard/jer016. View

Stone G, Lindenfeld J, Abraham W, Kar S, Lim D, Mishell J . Transcatheter Mitral-Valve Repair in Patients with Heart Failure. N Engl J Med. 2018; 379(24):2307-2318. DOI: 10.1056/NEJMoa1806640. View

Biaggi P, Jedrzkiewicz S, Gruner C, Meineri M, Karski J, Vegas A . Quantification of mitral valve anatomy by three-dimensional transesophageal echocardiography in mitral valve prolapse predicts surgical anatomy and the complexity of mitral valve repair. J Am Soc Echocardiogr. 2012; 25(7):758-65. DOI: 10.1016/j.echo.2012.03.010. View

Yao G, Deng Y, Liu Y, Xu M, Zhang C, Deng Y . Echocardiographic measurements in normal chinese adults focusing on cardiac chambers and great arteries: a prospective, nationwide, and multicenter study. J Am Soc Echocardiogr. 2015; 28(5):570-9. DOI: 10.1016/j.echo.2015.01.022. View

Miyoshi T, Addetia K, Citro R, Daimon M, Desale S, Gutierrez Fajardo P . Left Ventricular Diastolic Function in Healthy Adult Individuals: Results of the World Alliance Societies of Echocardiography Normal Values Study. J Am Soc Echocardiogr. 2020; 33(10):1223-1233. DOI: 10.1016/j.echo.2020.06.008. View

Tang Z, Fan Y, Wang Y, Jin C, Kwok K, Lee A . Mitral Annular and Left Ventricular Dynamics in Atrial Functional Mitral Regurgitation: A Three-Dimensional and Speckle-Tracking Echocardiographic Study. J Am Soc Echocardiogr. 2019; 32(4):503-513. DOI: 10.1016/j.echo.2018.11.009. View

10.

Anwar A, Soliman O, Nemes A, Germans T, Krenning B, Geleijnse M . Assessment of mitral annulus size and function by real-time 3-dimensional echocardiography in cardiomyopathy: comparison with magnetic resonance imaging. J Am Soc Echocardiogr. 2007; 20(8):941-8. DOI: 10.1016/j.echo.2007.01.026. View

11.

Angelo L, Vieira M, Rodrigues S, Morelato R, Pereira A, Mill J . Echocardiographic reference values in a sample of asymptomatic adult Brazilian population. Arq Bras Cardiol. 2007; 89(3):168-73, 184-90. DOI: 10.1590/s0066-782x2007001500007. View

12.

Maffessanti F, Gripari P, Pontone G, Andreini D, Bertella E, Mushtaq S . Three-dimensional dynamic assessment of tricuspid and mitral annuli using cardiovascular magnetic resonance. Eur Heart J Cardiovasc Imaging. 2013; 14(10):986-95. DOI: 10.1093/ehjci/jet004. View

13.

Lang R, Mor-Avi V, Sugeng L, Nieman P, Sahn D . Three-dimensional echocardiography: the benefits of the additional dimension. J Am Coll Cardiol. 2006; 48(10):2053-69. DOI: 10.1016/j.jacc.2006.07.047. View

14.

Mathur R, Bhaskaran K, Chaturvedi N, Leon D, vanStaa T, Grundy E . Completeness and usability of ethnicity data in UK-based primary care and hospital databases. J Public Health (Oxf). 2013; 36(4):684-92. PMC: 4245896. DOI: 10.1093/pubmed/fdt116. View

15.

Topilsky Y, Vaturi O, Watanabe N, Bichara V, Nkomo V, Michelena H . Real-time 3-dimensional dynamics of functional mitral regurgitation: a prospective quantitative and mechanistic study. J Am Heart Assoc. 2013; 2(3):e000039. PMC: 3698758. DOI: 10.1161/JAHA.113.000039. View

16.

Pressman G, Movva R, Topilsky Y, Clavel M, Saldanha J, Watanabe N . Mitral Annular Dynamics in Mitral Annular Calcification: A Three-Dimensional Imaging Study. J Am Soc Echocardiogr. 2015; 28(7):786-94. DOI: 10.1016/j.echo.2015.03.002. View

17.

Bartels K, Thiele R, Phillips-Bute B, Glower D, Swaminathan M, Kisslo J . Dynamic indices of mitral valve function using perioperative three-dimensional transesophageal echocardiography. J Cardiothorac Vasc Anesth. 2013; 28(1):18-24. DOI: 10.1053/j.jvca.2013.03.024. View

18.

Bansal M, Mohan J, Sengupta S . Normal echocardiographic measurements in Indian adults: How different are we from the western populations? A pilot study. Indian Heart J. 2016; 68(6):772-775. PMC: 5143821. DOI: 10.1016/j.ihj.2016.02.018. View

19.

Mihaila S, Muraru D, Piasentini E, Miglioranza M, Peluso D, Cucchini U . Quantitative analysis of mitral annular geometry and function in healthy volunteers using transthoracic three-dimensional echocardiography. J Am Soc Echocardiogr. 2014; 27(8):846-57. DOI: 10.1016/j.echo.2014.04.017. View

20.

Singh A, Singulane C, Miyoshi T, Prado A, Addetia K, Bellino M . Normal Values of Left Atrial Size and Function and the Impact of Age: Results of the World Alliance Societies of Echocardiography Study. J Am Soc Echocardiogr. 2021; 35(2):154-164.e3. DOI: 10.1016/j.echo.2021.08.008. View