title: Morphofunctional Abnormalities of Mitral Annulus and Arrhythmic Mitral Valve Prolapse.
abstract: Arrhythmic mitral valve prolapse (MVP) is characterized by myxomatous leaflets and left ventricular (LV) fibrosis of papillary muscles and inferobasal wall. We searched for morphofunctional abnormalities of the mitral valve that could explain a regional mechanical myocardial stretch.
  
  
  
  Thirty-six (27 female patients; median age: 44 years) arrhythmic MVP patients with LV late gadolinium enhancement on cardiac magnetic resonance and no or trivial mitral regurgitation, and 16 (6 female patients; median age: 40 years) MVP patients without LV late gadolinium enhancement were investigated by morphofunctional cardiac magnetic resonance. Mitral annulus disjunction (median: 4.8 versus 1.8 mm; P<0.001), end-systolic mitral annular diameters (median: 41.2 versus 31.5; P=0.004) and end-diastolic mitral annular diameters (median: 35.5 versus 31.5; P=0.042), prevalence of posterior systolic curling (34 [94%] versus 3 [19%]; P<0.001), and basal to mid LV wall thickness ratio >1.5 (22 [61%] versus 4 [25%]; P=0.016) were higher in MVP patients with late gadolinium enhancement than in those without. A linear correlation was found between mitral annulus disjunction and curling (R=0.85). A higher prevalence of auscultatory midsystolic click (26 [72%] versus 6 [38%]; P=0.018) was also noted. Histology of the mitral annulus showed a longer mitral annulus disjunction in 50 sudden death patients with MVP and LV fibrosis than in 20 patients without MVP (median: 3 versus 1.5 mm; P<0.001).
  
  
  
  Mitral annulus disjunction is a constant feature of arrhythmic MVP with LV fibrosis. The excessive mobility of the leaflets caused by posterior systolic curling accounts for a mechanical stretch of the inferobasal wall and papillary muscles, eventually leading to myocardial hypertrophy and scarring. These mitral annulus abnormalities, together with auscultatory midsystolic click, may identify MVP patients who would need arrhythmic risk stratification.
authors: From the Department of Cardiac, Thoracic, and Vascular Sciences (M.P.M., C.B., M.D.L., S.R., A.C., I.R., F.M., K.P., L.C., E.B., A.C.F., B.B., D.C., G.T., S.I.), Department of Medicine (B.G.), and Department of Radiology (C.L.), Azienda Ospedaliera-University of Padua Medical School, Italy. martina.perazzolomarra@unipd.it.
authors: Martina
authors: M
authors: Perazzolo Marra
authors: From the Department of Cardiac, Thoracic, and Vascular Sciences (M.P.M., C.B., M.D.L., S.R., A.C., I.R., F.M., K.P., L.C., E.B., A.C.F., B.B., D.C., G.T., S.I.), Department of Medicine (B.G.), and Department of Radiology (C.L.), Azienda Ospedaliera-University of Padua Medical School, Italy.
authors: Cristina
authors: C
authors: Basso
authors: From the Department of Cardiac, Thoracic, and Vascular Sciences (M.P.M., C.B., M.D.L., S.R., A.C., I.R., F.M., K.P., L.C., E.B., A.C.F., B.B., D.C., G.T., S.I.), Department of Medicine (B.G.), and Department of Radiology (C.L.), Azienda Ospedaliera-University of Padua Medical School, Italy.
authors: Manuel
authors: M
authors: De Lazzari
authors: From the Department of Cardiac, Thoracic, and Vascular Sciences (M.P.M., C.B., M.D.L., S.R., A.C., I.R., F.M., K.P., L.C., E.B., A.C.F., B.B., D.C., G.T., S.I.), Department of Medicine (B.G.), and Department of Radiology (C.L.), Azienda Ospedaliera-University of Padua Medical School, Italy.
authors: Stefania
authors: S
authors: Rizzo
authors: From the Department of Cardiac, Thoracic, and Vascular Sciences (M.P.M., C.B., M.D.L., S.R., A.C., I.R., F.M., K.P., L.C., E.B., A.C.F., B.B., D.C., G.T., S.I.), Department of Medicine (B.G.), and Department of Radiology (C.L.), Azienda Ospedaliera-University of Padua Medical School, Italy.
authors: Alberto
authors: A
authors: Cipriani
authors: From the Department of Cardiac, Thoracic, and Vascular Sciences (M.P.M., C.B., M.D.L., S.R., A.C., I.R., F.M., K.P., L.C., E.B., A.C.F., B.B., D.C., G.T., S.I.), Department of Medicine (B.G.), and Department of Radiology (C.L.), Azienda Ospedaliera-University of Padua Medical School, Italy.
authors: Benedetta
authors: B
authors: Giorgi
authors: From the Department of Cardiac, Thoracic, and Vascular Sciences (M.P.M., C.B., M.D.L., S.R., A.C., I.R., F.M., K.P., L.C., E.B., A.C.F., B.B., D.C., G.T., S.I.), Department of Medicine (B.G.), and Department of Radiology (C.L.), Azienda Ospedaliera-University of Padua Medical School, Italy.
authors: Carmelo
authors: C
authors: Lacognata
authors: From the Department of Cardiac, Thoracic, and Vascular Sciences (M.P.M., C.B., M.D.L., S.R., A.C., I.R., F.M., K.P., L.C., E.B., A.C.F., B.B., D.C., G.T., S.I.), Department of Medicine (B.G.), and Department of Radiology (C.L.), Azienda Ospedaliera-University of Padua Medical School, Italy.
authors: Ilaria
authors: I
authors: Rigato
authors: From the Department of Cardiac, Thoracic, and Vascular Sciences (M.P.M., C.B., M.D.L., S.R., A.C., I.R., F.M., K.P., L.C., E.B., A.C.F., B.B., D.C., G.T., S.I.), Department of Medicine (B.G.), and Department of Radiology (C.L.), Azienda Ospedaliera-University of Padua Medical School, Italy.
authors: Federico
authors: F
authors: Migliore
authors: From the Department of Cardiac, Thoracic, and Vascular Sciences (M.P.M., C.B., M.D.L., S.R., A.C., I.R., F.M., K.P., L.C., E.B., A.C.F., B.B., D.C., G.T., S.I.), Department of Medicine (B.G.), and Department of Radiology (C.L.), Azienda Ospedaliera-University of Padua Medical School, Italy.
authors: Kalliopi
authors: K
authors: Pilichou
authors: From the Department of Cardiac, Thoracic, and Vascular Sciences (M.P.M., C.B., M.D.L., S.R., A.C., I.R., F.M., K.P., L.C., E.B., A.C.F., B.B., D.C., G.T., S.I.), Department of Medicine (B.G.), and Department of Radiology (C.L.), Azienda Ospedaliera-University of Padua Medical School, Italy.
authors: Luisa
authors: L
authors: Cacciavillani
authors: From the Department of Cardiac, Thoracic, and Vascular Sciences (M.P.M., C.B., M.D.L., S.R., A.C., I.R., F.M., K.P., L.C., E.B., A.C.F., B.B., D.C., G.T., S.I.), Department of Medicine (B.G.), and Department of Radiology (C.L.), Azienda Ospedaliera-University of Padua Medical School, Italy.
authors: Emanuele
authors: E
authors: Bertaglia
authors: From the Department of Cardiac, Thoracic, and Vascular Sciences (M.P.M., C.B., M.D.L., S.R., A.C., I.R., F.M., K.P., L.C., E.B., A.C.F., B.B., D.C., G.T., S.I.), Department of Medicine (B.G.), and Department of Radiology (C.L.), Azienda Ospedaliera-University of Padua Medical School, Italy.
authors: Anna Chiara
authors: AC
authors: Frigo
authors: From the Department of Cardiac, Thoracic, and Vascular Sciences (M.P.M., C.B., M.D.L., S.R., A.C., I.R., F.M., K.P., L.C., E.B., A.C.F., B.B., D.C., G.T., S.I.), Department of Medicine (B.G.), and Department of Radiology (C.L.), Azienda Ospedaliera-University of Padua Medical School, Italy.
authors: Barbara
authors: B
authors: Bauce
authors: From the Department of Cardiac, Thoracic, and Vascular Sciences (M.P.M., C.B., M.D.L., S.R., A.C., I.R., F.M., K.P., L.C., E.B., A.C.F., B.B., D.C., G.T., S.I.), Department of Medicine (B.G.), and Department of Radiology (C.L.), Azienda Ospedaliera-University of Padua Medical School, Italy.
authors: Domenico
authors: D
authors: Corrado
authors: From the Department of Cardiac, Thoracic, and Vascular Sciences (M.P.M., C.B., M.D.L., S.R., A.C., I.R., F.M., K.P., L.C., E.B., A.C.F., B.B., D.C., G.T., S.I.), Department of Medicine (B.G.), and Department of Radiology (C.L.), Azienda Ospedaliera-University of Padua Medical School, Italy.
authors: Gaetano
authors: G
authors: Thiene
authors: From the Department of Cardiac, Thoracic, and Vascular Sciences (M.P.M., C.B., M.D.L., S.R., A.C., I.R., F.M., K.P., L.C., E.B., A.C.F., B.B., D.C., G.T., S.I.), Department of Medicine (B.G.), and Department of Radiology (C.L.), Azienda Ospedaliera-University of Padua Medical School, Italy.
authors: Sabino
authors: S
authors: Iliceto
mesh_terms: D000328:Adult; D001145:Arrhythmias, Cardiac / Q000150:complications* / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology; D001706:Biopsy; D003287:Contrast Media / Q000008:administration & dosage; D016757:Death, Sudden, Cardiac / Q000209:etiology; D004452:Echocardiography; D015716:Electrocardiography, Ambulatory; D005260:Female; D005355:Fibrosis; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D016014:Linear Models; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000503:physiopathology*; D008945:Mitral Valve Prolapse / Q000000981:diagnostic imaging / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D010210:Papillary Muscles / Q000000981:diagnostic imaging / Q000503:physiopathology; D011379:Prognosis; D012307:Risk Factors; D016277:Ventricular Function, Left; D055815:Young Adult
chemical_list: D003287:Contrast Media
keywords: gadolinium; mitral valve; mitral valve annulus; mitral valve prolapse; papillary muscles