title: Mitral Annular Dimensions and Geometry in Patients With Functional Mitral Regurgitation and Mitral Valve Prolapse: Implications for Transcatheter Mitral Valve Implantation.
abstract: OBJECTIVE
  The aims of this study were to determine D-shaped mitral annulus (MA) dimensions in control subjects without significant cardiac disease and in patients with moderate to severe mitral regurgitation (MR) being considered for transcatheter mitral therapy and to determine predictors of annular size, using cardiac computed tomography.
  
  
  BACKGROUND
  The recently introduced D-shaped method of MA segmentation represents a biomechanically appropriate approach for annular sizing prior to transcatheter mitral valve implantation.
  
  
  METHODS
  Patients who had retrospectively gated cardiac computed tomography performed at our institution (2012 to 2014) and were free of significant cardiac disease were included as controls (n = 88; 56 ± 11 years of age; 47% female) and were compared with patients with moderate or severe MR due to functional mitral regurgitation (FMR) (n = 27) or mitral valve prolapse (MVP) (n = 32). MA dimensions (projected area, perimeter, intercommissural, and septal-to-lateral distance), maximal left atrial (LA) volumes, and phasic left ventricular volumes were measured.
  
  
  RESULTS
  MA dimensions were larger in patients with FMR or MVP compared with controls (area index 4.7 ± 0.6 cm(2)/m(2), 6.0 ± 1.3 cm(2)/m(2), and 7.3 ± 1.7 cm(2)/m(2); perimeter index 59 ± 5 mm/m(2), 67 ± 9 mm/m(2), and 75 ± 10 mm/m(2); intercommissural distance index 20.2 ± 1.9 mm/m(2), 21.2 ± 3.1 mm/m(2), and 24.7 ± 3.2 mm/m(2); septal-to-lateral distance index 14.8 ± 1.6, 18.1 ± 3.3, and 19.5 ± 3.4 mm/m(2) in controls and patients with FMR and MVP, respectively; p < 0.05 between controls and MR subgroups). Absolute MA area was 18% larger in patients with MVP than patients with FMR (13.0 ± 2.9 cm(2) vs. 11.0 ± 2.3 cm(2); p = 0.006). Although LA and left ventricular volumes were both independently associated with MA area index in controls and patients with MVP, only LA volume was associated with annular size in patients with FMR.
  
  
  CONCLUSIONS
  Moderate to severe MR was associated with increased MA dimensions, especially among patients with MVP compared with control subjects without cardiac disease. Moreover, unlike in controls and patients with MVP, annular enlargement in FMR was more closely associated with LA dilation.
authors.affiliation: St. Paul's Hospital and University of British Columbia, Center for Heart Valve Innovation, Vancouver, British Columbia, Canada.
authors.forename: Christopher
authors.initials: C
authors.lastname: Naoum
authors.affiliation: St. Paul's Hospital and University of British Columbia, Center for Heart Valve Innovation, Vancouver, British Columbia, Canada.
authors.forename: Jonathon
authors.initials: J
authors.lastname: Leipsic
authors.affiliation: St. Paul's Hospital and University of British Columbia, Center for Heart Valve Innovation, Vancouver, British Columbia, Canada.
authors.forename: Anson
authors.initials: A
authors.lastname: Cheung
authors.affiliation: St. Paul's Hospital and University of British Columbia, Center for Heart Valve Innovation, Vancouver, British Columbia, Canada.
authors.forename: Jian
authors.initials: J
authors.lastname: Ye
authors.affiliation: St. Paul's Hospital and University of British Columbia, Center for Heart Valve Innovation, Vancouver, British Columbia, Canada.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Bilbey
authors.affiliation: St. Paul's Hospital and University of British Columbia, Center for Heart Valve Innovation, Vancouver, British Columbia, Canada.
authors.forename: George
authors.initials: G
authors.lastname: Mak
authors.affiliation: St. Paul's Hospital and University of British Columbia, Center for Heart Valve Innovation, Vancouver, British Columbia, Canada.
authors.forename: Adam
authors.initials: A
authors.lastname: Berger
authors.affiliation: St. Paul's Hospital and University of British Columbia, Center for Heart Valve Innovation, Vancouver, British Columbia, Canada.
authors.forename: Danny
authors.initials: D
authors.lastname: Dvir
authors.affiliation: St. Paul's Hospital and University of British Columbia, Center for Heart Valve Innovation, Vancouver, British Columbia, Canada.
authors.forename: Chesnal
authors.initials: C
authors.lastname: Arepalli
authors.affiliation: St. Paul's Hospital and University of British Columbia, Center for Heart Valve Innovation, Vancouver, British Columbia, Canada.
authors.forename: Jasmine
authors.initials: J
authors.lastname: Grewal
authors.affiliation: St. Vincent's Hospital, Sydney, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Muller
authors.affiliation: St. Paul's Hospital and University of British Columbia, Center for Heart Valve Innovation, Vancouver, British Columbia, Canada.
authors.forename: Darra
authors.initials: D
authors.lastname: Murphy
authors.affiliation: St. Paul's Hospital and University of British Columbia, Center for Heart Valve Innovation, Vancouver, British Columbia, Canada.
authors.forename: Cameron
authors.initials: C
authors.lastname: Hague
authors.affiliation: Department of Medicine, Division of Cardiology, McGill University Health Centre, Montreal, Quebec, Canada.
authors.forename: Nicolo
authors.initials: N
authors.lastname: Piazza
authors.affiliation: St. Paul's Hospital and University of British Columbia, Center for Heart Valve Innovation, Vancouver, British Columbia, Canada.
authors.forename: John
authors.initials: J
authors.lastname: Webb
authors.affiliation: St. Paul's Hospital and University of British Columbia, Center for Heart Valve Innovation, Vancouver, British Columbia, Canada. Electronic address: phil.blanke@googlemail.com.
authors.forename: Philipp
authors.initials: P
authors.lastname: Blanke
mesh_terms: D000368:Aged; D006328:Cardiac Catheterization; D055424:Cardiac-Gated Imaging Techniques; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging* / Q000503:physiopathology; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000628:therapy*; D008945:Mitral Valve Prolapse / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000628:therapy*; D061330:Multidetector Computed Tomography; D018579:Patient Selection; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012720:Severity of Illness Index
keywords: TMVI; TMVR; computed tomography; mitral annulus; mitral regurgitation; transcatheter mitral valve implantation