Secondary leaflet tethering in patients with severe degenerative mitral regurgitation and its association with the severity of mitral regurgitation

Zhenyi Ge; Chunqiang Hu; Yingjie Zhao; Fangyan Tian; Yongshi Wang; Dehong Kong; Wei Li; Yashu Xie; Zhengdan Ge; Zibire Fulati; Yufei Cheng; Yao Guo; Yingying Jiang; Cuizhen Pan; Xianhong Shu

doi:10.1111/echo.15657

Secondary leaflet tethering in patients with severe degenerative mitral regurgitation and its association with the severity of mitral regurgitation

Echocardiography. 2023 Sep;40(9):932-941. doi: 10.1111/echo.15657. Epub 2023 Jul 27.

Authors

Zhenyi Ge^{1

2}, Chunqiang Hu^{1

2}, Yingjie Zhao^{1

2}, Fangyan Tian^{1

2}, Yongshi Wang¹, Dehong Kong¹, Wei Li¹, Yashu Xie³, Zhengdan Ge^{1

2}, Zibire Fulati¹, Yufei Cheng¹, Yao Guo¹, Yingying Jiang¹, Cuizhen Pan^{1

2}, Xianhong Shu^{1

2}

Affiliations

¹ Department of Echocardiography, Shanghai Institute of Cardiovascular Disease, Zhongshan Hospital, Fudan University, Shanghai, China.
² Shanghai Institute of Medical Imaging, Fudan University, Shanghai, China.
³ ChengDu Healthcare Security Administration, Sichuan, China.

PMID: 37498192
DOI: 10.1111/echo.15657

Abstract

Background: The purpose of the study was to determine the association between vena contracta area (VCA) and secondary leaflet tethering among mitral valve prolapse (MVP) patients, and thus to further identify and characterize an MVP with pathological leaflet tethering (MVPt+) phenotype.

Methods: We prospectively evaluated 94 consecutive MVP patients with significant mitral regurgitation (MR) and 21 healthy controls. MVPt+ group was defined as tenting volume index (TVi) > .7 mL/m² . The three-dimensional (3D) geometry of mitral valve apparatus and VCA was measured with dedicated quantification software.

Results: Of the 94 patients with MVP and significant MR, 31 patients showed a TVi > .7 mL/m² and entered the MVP with leaflet tethering (MVPt+) group. In stepwise multivariate analysis, only prolapse volume index and TVi were independently associated with 3D VCA. 3D VCA, annular area index, and plasma levels of NT-proBNP were independently correlated with the severity of leaflet tethering. ROC curve revealed that a 3D VCA ≥ .55 cm² is the optimal cutoff point to predict MVPt+ phenotype.

Conclusions: Secondary leaflet tethering is a significant mechanism behind severe degenerative MR, resulting in an MVPt+ phenotype featuring more advanced morphological and hemodynamical characteristics.

Keywords: 3D transesophageal echocardiography; degenerative mitral regurgitation; mitral valve geometry; mitral valve prolapse.

MeSH terms

Echocardiography, Three-Dimensional* / methods
Echocardiography, Transesophageal / methods
Humans
Mitral Valve / diagnostic imaging
Mitral Valve Insufficiency* / complications
Mitral Valve Insufficiency* / diagnostic imaging
Mitral Valve Prolapse* / complications

Abstract

MeSH terms

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