title: Quantitative analysis of mitral annular geometry and function in healthy volunteers using transthoracic three-dimensional echocardiography.
abstract: BACKGROUND
  Quantitative assessment of the mitral annulus provides information regarding the pathophysiology of mitral regurgitation and aids in the planning of reparative surgery. Three-dimensional (3D) transthoracic echocardiographic data sets acquired with current scanners have enough spatial and temporal resolution to allow the quantitative analysis of the mitral annulus. Accordingly, the authors performed (1) a validation study to assess the agreement of quantitative analysis of the mitral annulus performed on 3D transthoracic echocardiography (TTE) and 3D transesophageal echocardiography (TEE) and (2) a normative study to obtain the reference values of 3D transthoracic echocardiographic parameters for mitral annular (MA) geometry and dynamics.
  
  
  METHODS
  Mitral valve data sets were obtained by 3D TEE and 3D TTE in 30 consecutive patients with clinically indicated TEE (validation study) and 3D TTE in 224 healthy volunteers (aged 18-76 years) (normative study).
  
  
  RESULTS
  In the validation study, MA measurements obtained by 3D TTE were similar to those obtained by 3D TEE (P = NS). In the normative study, MA analysis by 3D TTE was feasible (94.5%) and reproducible (intraclass correlation coefficient = 0.78-0.97). MA diameters, area, and circumference were correlated with body surface area (r > 0.50 for all) but not with age. Men had larger MA areas than women (4.9 ± 1.0 vs 4.5 ± 0.7 cm(2)/m(2), P = .004). During systole, MA area decreased by 29 ± 5%. This decrease was related mainly to anteroposterior diameter shortening (20 ± 7%).
  
  
  CONCLUSIONS
  MA quantitative analysis by 3D TTE was accurate compared with 3D TEE in unselected patients with mitral valve disease. In healthy subjects, it was highly feasible and reproducible. The availability of reference values for MA geometry and dynamics may foster the implementation of MA quantitative analysis by 3D TTE in clinical settings.
authors.affiliation: Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy; University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania.
authors.forename: Sorina
authors.initials: S
authors.lastname: Mihăilă
authors.affiliation: Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy.
authors.forename: Denisa
authors.initials: D
authors.lastname: Muraru
authors.affiliation: Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy.
authors.forename: Eleonora
authors.initials: E
authors.lastname: Piasentini
authors.affiliation: Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy; Cardiology Institute of Rio Grande do Sul, Porto Alegre, Brazil.
authors.forename: Marcelo Haertel
authors.initials: MH
authors.lastname: Miglioranza
authors.affiliation: Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy.
authors.forename: Diletta
authors.initials: D
authors.lastname: Peluso
authors.affiliation: Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy.
authors.forename: Umberto
authors.initials: U
authors.lastname: Cucchini
authors.affiliation: Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy.
authors.forename: Sabino
authors.initials: S
authors.lastname: Iliceto
authors.affiliation: University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania.
authors.forename: Dragoş
authors.initials: D
authors.lastname: Vinereanu
authors.affiliation: Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy. Electronic address: lpbadano@gmail.com.
authors.forename: Luigi P
authors.initials: LP
authors.lastname: Badano
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D019560:Echocardiography, Three-Dimensional / Q000379:methods*; D017548:Echocardiography, Transesophageal / Q000379:methods*; D005260:Female; D064368:Healthy Volunteers; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging*; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging*; D012372:ROC Curve; D015203:Reproducibility of Results; D012189:Retrospective Studies; D055815:Young Adult
keywords: Mitral annulus; Mitral valve; Normal subjects; Reference values; Three-dimensional echocardiography; Transesophageal echocardiography; Transthoracic echocardiography