Mitral Annular Function in Mitral Annular Calcification and Severe Mitral Regurgitation

JACC advances Pub Date : 2025-09-17 DOI:10.1016/j.jacadv.2025.102161

Joseph Kassab MD, MS , Joseph Hajj MD , Serge C. Harb MD , Rhonda Miyasaka MD , Grant Reed MD, MSc , Amar Krishnaswamy MD , Kari Feldt MD , Christopher U. Meduri MD, MPH , A. Marc Gillinov MD , Shinya Unai MD , James J. Yun MD, PhD , Marcus Carlsson MD , Samir R. Kapadia MD , Rishi Puri MD, PhD

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引用次数: 0

Abstract

Background

Longitudinal left ventricular (LV) shortening, or mitral atrioventricular plane displacement (AVPD), reflects mitral annular function.

Objectives

The authors sought to demonstrate the use of cardiac computed tomography (CCT) to measure mitral AVPD and assess its contribution to LV stroke volume (LVSV) in patients with mitral annular calcification (MAC), severe functional mitral regurgitation (FMR), and severe primary mitral regurgitation (PMR) without MAC.

Methods

We included 200 patients with circumferential MAC (age 79.6 ± 10 years), 50 with severe FMR (age 74 ± 8 years), 50 with severe PMR (age 83 ± 10 years), and 50 control subjects (age 41.6 ± 16 years) who underwent CCT (2016-2022). AVPD was measured in all patients. The volume of blood attributable to AVPD (V^AVPD) and its fractional contribution to LVSV (SV^AVPD%) were calculated across all cohorts. Group comparisons were performed using t-tests, analysis of variance, and Chi-square tests; multivariable linear regression was used to identify independent associations with AVPD and SV^AVPD%.

Results

Mean AVPD differed significantly between controls, PMR, and FMR patients (11.9, 6.6, 9.9 mm; P < 0.0001), whereas SV^AVPD% was similar (45.8%, 46.5%, 45.5%; P = 0.94). Among MAC patients, AVPD decreased with increasing severity (P < 0.0001). Those with grade 3 to 4 MAC had significantly lower SV^AVPD% compared to non-MAC groups (26.7% to 28.9% vs 45.5% to 46.5%; P < 0.0001). MAC severity was independently associated with reduced AVPD and SV^AVPD% (P < 0.0001).

Conclusions

CCT can quantify mitral annular function and its contribution to LVSV. Moderate-to-severe MAC significantly impairs annular function, reducing its share of LVSV. These findings may inform patient selection for transcatheter mitral therapies that impact annular dynamics.

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二尖瓣环钙化和严重二尖瓣返流的二尖瓣功能。

背景：纵向左心室（LV）缩短，或二尖瓣房室平面位移（AVPD），反映二尖瓣环功能。目的：作者试图证明使用心脏计算机断层扫描（CCT）来测量二尖瓣AVPD，并评估其对二尖瓣环钙化（MAC），严重功能性二尖瓣反流（FMR）和严重原发性二尖瓣反流（PMR）无MAC患者左室卒中容积（LVSV）的贡献。我们纳入了200例周向MAC患者（年龄79.6±10岁），50例严重FMR患者（年龄74±8岁），50例严重PMR患者（年龄83±10岁），以及50例接受CCT的对照患者（年龄41.6±16岁）（2016-2022）。所有患者均测量AVPD。计算所有队列中AVPD的血容量（VAVPD）及其对LVSV的分数贡献（SVAVPD%）。采用t检验、方差分析和卡方检验进行组间比较；使用多变量线性回归确定与AVPD和SVAVPD%的独立关联。结果：平均AVPD在对照组、PMR和FMR患者之间差异显著（11.9、6.6、9.9 mm; P < 0.0001），而SVAVPD%相似（45.8%、46.5%、45.5%;P = 0.94）。在MAC患者中，AVPD随严重程度的增加而降低（P < 0.0001）。与非MAC组相比，3至4级MAC组的SVAVPD%显著降低（26.7%至28.9% vs 45.5%至46.5%;P < 0.0001）。MAC严重程度与AVPD和SVAVPD%降低独立相关（P < 0.0001）。结论：CCT可以量化二尖瓣环功能及其对LVSV的影响。中度至重度MAC显著损害环空功能，降低其LVSV份额。这些发现可以为患者选择影响二尖瓣动力学的经导管二尖瓣治疗提供信息。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

JACC advances Cardiology and Cardiovascular Medicine

CiteScore

1.90

自引率

0.00%

发文量