Pathophysiology of Degenerative Mitral Regurgitation

Antoine, Clémence; Mantovani, Francesca; Benfari, Giovanni; Mankad, Sunil; Maalouf, Joseph F.; Michelena, Héctor I.; Enríquez-Sarano, Maurice

doi:10.1161/circimaging.116.005971

Cited by 52 publications

(53 citation statements)

References 55 publications

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“…35 As for mitral regurgitation, a process of direct valve leaflet damage and indirect ring dilatation might be involved. 36,37 Further mechanistic research could explore the different pathways.…”

Section: Discussionmentioning

confidence: 99%

Systolic Blood Pressure and Risk of Valvular Heart Disease

et al. 2019

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factors for valvular heart disease remain largely unknown, which limits prevention and treatment. OBJECTIVE To assess the association between systolic blood pressure (BP) and major valvular heart disease. DESIGN, SETTING, AND PARTICIPANTS A UK Biobank population-based cohort of 502 602 men and women aged 40 to 96 years at baseline was evaluated through mendelian randomization using individual participant data. Inclusion criteria were valid genetic data and BP measurements. The participants were recruited between 2006 and 2010; data analysis was performed from June 2018 to January 2019. EXPOSURES Systolic BP was measured during clinical assessment and instruments for the genetic effect of high BP were identified from variants that were independently (linkage disequilibrium threshold of r 2 <0.1) associated with systolic BP with minor allele frequency greater than 0.01. A total of 130 single-nucleotide polymorphisms that have been shown to be associated with systolic BP in a genome-wide association meta-analysis involving 1 million participants of European ancestry were selected. MAIN OUTCOMES AND MEASURES Incident aortic stenosis, aortic regurgitation, and mitral regurgitation, individually and combined. Cases were largely based on hospital records linked to the UK Biobank with International Classification of Diseases and Health Related Problems, Tenth Revision codes. RESULTS Of the 502 602 individuals screened, 329 237 participants (177 741 [53.99%] women; mean [SD] age, 56.93 [7.99] years) had valid genetic data and BP measurements; of this cohort, 3570 individuals (1.08%) had a diagnosis of valvular heart disease (aortic stenosis, 1491 [0.45%]; aortic regurgitation, 634 [0.19%]; and mitral regurgitation, 1736 [0.53%]). Each genetically associated 20-mm Hg increment in systolic BP was associated with an increased risk of aortic stenosis (odds ratio [OR], 3.26; 95% CI, 1.50-7.10), aortic regurgitation (OR, 2.59; 95% CI, 0.75-8.92), and mitral regurgitation (OR, 2.19; 95% CI, 1.07-4.47), with no evidence for heterogeneity by type of valvular heart disease (P = .90). Sensitivity analyses confirmed the robustness of the association. CONCLUSIONS AND RELEVANCE Lifetime exposure to elevated systolic BP appears to be associated with an increased risk of major valvular heart disease.

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Section: Discussionmentioning

confidence: 99%

Systolic Blood Pressure and Risk of Valvular Heart Disease

et al. 2019

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“…Currently, the gold standards in diagnostics of MVP are physical examination and two-dimensional (2D) echocardiography (11). Other methods which allow more detailed imaging of mitral valve in MVP include three-dimensional (3D) echocardiography (19) and 2D transoesophageal echocardiography (TEE), which represent very good identifiers of accurate localization of MVP (20). Nowadays, cardiac magnetic resonance imaging belongs to useful non-invasive methods for identifying MVP itself and MVP-related regurgitation (21).…”

Section: Sympathovagal Dynamic Balance -Functionmentioning

confidence: 99%

Sympathetic nervous system and cardiovascular risk in mitral valve prolapse

Olexova

Mestanik

Jurko

et al. 2019

Acta Medica Martiniana

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Mitral valve prolapse (MVP) represents a frequent cardiovascular condition associated with increased cardiovascular risk, which may have progressive course and become malignant. Dysregulation of autonomic nervous system - especially sympathetic overdrive – is one of the factors considered to play a key role in its aetiology and development. There is a growing evidence of a large impact of sympathetic system on the development of MVP. Exaggerated sympathetic activity may lead to morphologic changes in valves tissue such as thickening and redundancy. Nowadays, few investigative methods are known for evaluation of the regulatory state of sympathetic nervous system, which could be, theoretically, used to identify the subjects with sympathetic overactivity associated with an increased cardiovascular risk. Electrodermal activity or blood pressure variability represent promising non-invasive methods for evaluation of the regulatory outputs of sympathetic nervous system. There is a possibility to extend a set of investigative methods in MVP and include the monitoring of sympathetic activity in the assessment of cardiovascular risk. This article summarizes knowledge about pathogenesis, diagnostic and therapeutical approaches of MVP, and brings some novel insights on the parameters of autonomic nervous regulation, which haven’t yet been used in cardiovascular risk assessment in MVP.

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“…Previous 3D echocardiographic studies highlighted morphological differences between FED and BD not only in leaflets, but also in MA 6,7. In FED in particular, MA dimensions and annulus height to commissural width ratio (AHCWR), which is an indicator of MA nonplanarity, are similar to normal mitral valves.…”

Section: Introductionmentioning

confidence: 98%

Mitral annulus morphometry in degenerative mitral regurgitation phenotypes

et al. 2020

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Objectives Degenerative mitral regurgitation (DMR) is classified into different phenotypes based on the extent of leaflet degeneration. Our aim is to demonstrate that phenotype complexity predicts the extent of structural abnormalities of mitral annulus (MA). Methods and results Seventy‐five patients with DMR and severe valve regurgitation and 23 patients with normal mitral valve were studied using 3D transesophageal echocardiography. Classification of DMR was done by allocating each 3D echocardiography result under five categories: fibroelastic deficiency (FED), FED+, forme fruste, Barlow’s disease Mitral annular disjunction (BD MAD)– or BD MAD+. MA was reconstructed in early systole and in end systole. We tested for a trend toward enlargement and flattening of MA in end systole and for a difference in MA dynamics from early systole to end systole with a worsening of DMR phenotype, in the whole spectrum of subjects ranging from controls to BD MAD+. A significant trend was observed toward larger anteroposterior diameter, intercommissural diameter, annulus circumference, and annulus area (P < .001). A reduction was found in annulus height to commissural width ratio (P = .003): This indicates a progressive MA flattening. Prolapse height and prolapse volume tended to be larger (P < .001). Conclusion Based on the extent of leaflet degeneration, DMR is classified into different phenotypes. As the disease progresses, a related increase in MA size is found, with rounder annular shape, loss of saddle shape, and increase in height and volume of leaflet prolapse. The most pronounced alterations are found in BD MAD+.

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Pathophysiology of Degenerative Mitral Regurgitation

Cited by 52 publications

References 55 publications

Systolic Blood Pressure and Risk of Valvular Heart Disease

Systolic Blood Pressure and Risk of Valvular Heart Disease

Sympathetic nervous system and cardiovascular risk in mitral valve prolapse

Mitral annulus morphometry in degenerative mitral regurgitation phenotypes

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