Mitral annular dynamics in mitral annular calcification : a three-dimensional imaging study

Authors: Pressman, Gregg; Movva, Rajesh; Topilsky, Yan; Clavel, Marie-Annick; Saldanha, Jason A.; Watanabe, Nozomi; Enriquez-Sarano, Maurice
Abstract: 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 6 0.6 vs 27.8 6 0.6 mm, P = .046), reduced height (2.8 6 0.2 vs 3.6 6 0.2 mm, P = .006), and decreased saddle shape (8.9 6 0.6% vs 11.4 6 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 calci- fication. 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. (J Am Soc Echocardiogr 2015;28:786-94.)
Document Type: Article de recherche
Issue Date: 30 March 2015
Open Access Date: Restricted access
Document version: VoR
This document was published in: Journal of the American Society of Echocardiography, Vol. 28 (7), 786–794 (2015)
American Society of Echocardiography
Alternative version: 10.1016/j.echo.2015.03.002
Collection:Articles publiés dans des revues avec comité de lecture

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