Analysis of shape and motion of the mitral annulus in subjects with and without cardiomyopathy by echocardiographic 3-dimensional reconstruction

Frank A. Flachskampf*, Shalabh Chandra, Ajeetkumar Gaddipatti, Robert A. Levine, Arthur E. Weyman, Walter Ameling, Peter Hanrath, James D. Thomas

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

134 Scopus citations

Abstract

The shape and dynamics of the mitral annulus of 10 patients without heart disease (controls), 3 patients with dilated cardiomyopathy, and 5 patients with hypertrophic obstructive cardiomyopathy and normal systolic function were analyzed by transesophageal echocardiography and 3-dimensional reconstruction. Mitral annular orifice area, apico-basal motion of the annulus, and nonplanarity were calculated over time. Annular area was largest in end diastole and smallest in end systole. Mean areas were 11.8 ± 2.5 cm2 (controls), 15.2 ± 4.2 cm2 (dilated cardiomyopathy), and 10.2 ± 2.4 cm2 (hypertrophic cardiomyopathy) (P = not significant). After correction for body surface, annuli from patients with normal left ventricular function were smaller than annuli from patients with dilated cardiomyopathy (5.9 ± 1.2 cm2/m2 vs 7.7 ± 1.0 cm2/m2; P < .02). The change in area during the cardiac cycle showed significant differences: 23.8% ± 5.1% (controls), 13.2% ± 2.3% (dilated cardiomyopathy), and 32.4% ± 7.6% (hypertrophic cardiomyopathy) (P < .001). Apico-basal motion was highest in controls, followed by those with hypertrophic obstructive and dilated cardiomyopathy (1.0 ± 0.3 cm, 0.8 ± 0.2 cm, 0.3 ± 0.2 cm, respectively; P < .01). Visual inspection and Fourier analysis showed a consistent pattern of anteroseptal and posterolateral elevations of the annulus toward the left atrium. In conclusion, although area changes and apico-basal motion of the mitral annulus strongly depend on left ventricular systolic function, nonplanarity is a structural feature preserved throughout the cardiac cycle in all three groups.

Original languageEnglish (US)
Pages (from-to)277-287
Number of pages11
JournalJournal of the American Society of Echocardiography
Volume13
Issue number4
DOIs
StatePublished - 2000

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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