Mechanism of mitral valve tethering caused by apical sparing contractility pattern in transthyretin amyloid cardiomyopathy.

IF 2.6 3区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS
Keitaro Shinada, Jin Endo, Hikaru Tsuruta, Akito Matsumura, Kohsuke Shirakawa, Marina Okada, Hidehiko Ikura, Hiroki Kitakata, Hidenori Moriyama, Masaki Ieda
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引用次数: 0

Abstract

Background: In transthyretin amyloid cardiomyopathy (ATTR-CM), pathological changes occur in the mitral valve, but the mechanism remains largely unknown. This study aimed to clarify the mechanism through quantitative analysis of the morphology and function of the mitral valve using three-dimensional (3D) echocardiography.

Methods: A total of 69 patients with ATTR-CM who underwent 3D transthoracic echocardiography from December 2015 to October 2022 were compared with 30 healthy controls.

Results: 3D echocardiographic analysis revealed increased mitral annular dilation and mitral valve tethering in patients with ATTR-CM. In the preserved left ventricular ejection fraction (ATTR-pEF) subgroup (n = 36), mitral valve tethering was more pronounced, despite normal mitral annular area. The rate of change in the distance between mitral annulus and papillary muscle was significantly higher in ATTR-CM patients and was an independent predictor of mitral valve tethering in the ATTR-pEF group. Among indices of left ventricular function, only the apical sparing ratio was correlated with this change ratio in the multivariate analysis.

Conclusion: Mitral valve tethering is observed in ATTR-CM regardless of EF. Apical sparing at systole increases in the mitral annulus-papillary muscle distance, leading to mitral valve tethering.

转甲状腺素淀粉样心肌病尖顶保留性收缩模式引起二尖瓣栓系的机制。
背景:转甲状腺素淀粉样心肌病(atr - cm)中,二尖瓣发生病理改变,但其机制尚不清楚。本研究旨在通过三维超声心动图对二尖瓣形态和功能的定量分析,阐明其发病机制。方法:将2015年12月至2022年10月接受三维经胸超声心动图检查的69例atr - cm患者与30例健康对照进行比较。结果:三维超声心动图分析显示,atr - cm患者二尖瓣环扩张增加,二尖瓣栓连。在保留左心室射血分数(atr - pef)亚组(n = 36)中,尽管二尖瓣环面积正常,但二尖瓣栓系更明显。在atr - cm患者中,二尖瓣环与乳头肌之间距离的变化率明显更高,并且是atr - pef组二尖瓣栓系的独立预测因子。在多变量分析中,左心室功能指标中只有心尖保留率与该变化率相关。结论:atr - cm不论EF大小均存在二尖瓣栓脱。收缩期尖顶保留增加二尖瓣环-乳头肌距离,导致二尖瓣栓系。
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来源期刊
Journal of cardiology
Journal of cardiology CARDIAC & CARDIOVASCULAR SYSTEMS-
CiteScore
4.90
自引率
8.00%
发文量
202
审稿时长
29 days
期刊介绍: The official journal of the Japanese College of Cardiology is an international, English language, peer-reviewed journal publishing the latest findings in cardiovascular medicine. Journal of Cardiology (JC) aims to publish the highest-quality material covering original basic and clinical research on all aspects of cardiovascular disease. Topics covered include ischemic heart disease, cardiomyopathy, valvular heart disease, vascular disease, hypertension, arrhythmia, congenital heart disease, pharmacological and non-pharmacological treatment, new diagnostic techniques, and cardiovascular imaging. JC also publishes a selection of review articles, clinical trials, short communications, and important messages and letters to the editor.
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