title: Basal Left Ventricular Dilatation and Reduced Contraction in Patients With Mitral Valve Prolapse Can Be Secondary to Annular Dilatation: Preoperative and Postoperative Speckle-Tracking Echocardiographic Study on Left Ventricle and Mitral Valve Annulus Interaction.
abstract: BACKGROUND
  Prominent mitral valve (MV) annular dilatation with only modest left ventricular (LV) dilatation in patients with MV prolapse (MVP) suggests predominant dilatation in adjacent basal LV, which may augment regional wall tension and attenuate contraction by Laplace's law. We hypothesized that MV annular dilatation in patients with MVP is associated with the basal predominance of LV dilatation and attenuated contraction, which can be altered by surgical MV plasty with annulus reduction.
  
  
  RESULTS
  Echocardiography with speckle-tracking analysis to assess regional cross-sectional short-axis area and longitudinal contraction (strain) of basal, middle, and apical LV was performed in 30 controls and 130 patients with MVP. The basal value/averaged middle and apical values (B/M·A ratio) of LV cross-sectional area and strain were obtained. Patients with MVP showed significantly greater MV annular area (6.4±1.6 versus 3.7±0.6 cm2/m2), increased B/M·A LV area ratio (2.4±0.5 versus 1.8±0.2), and reduced B/M·A LV strain ratio (0.83±0.14 versus 0.96±0.09) than controls (P<0.001). Multivariable analyses identified that MV annular dilatation was independently associated with increased B/M·A LV area ratio (β=0.60, P<0.001), which was associated with reduced B/M·A LV strain ratio (β=-0.32, P<0.001). In 35 patients with MVP, B/M·A LV area and strain ratio significantly altered after surgical MV plasty with annulus reduction (2.5±0.5-1.8±0.3 and 0.73±0.10-0.89±0.17, P<0.001, respectively).
  
  
  CONCLUSIONS
  In patients with MVP, MV annular dilatation was associated with the basal predominance of LV dilatation and reduced contraction, which can be altered by surgical MV plasty with annulus reduction, suggesting unfavorable influence from MV annular dilatation on basal LV.
authors.affiliation: From the Second Department of Internal Medicine (S.F., H.K., T.M., Y.O., S.S., Y.O.), Departments of Laboratory and Transfusion Medicine (M.T.), and Cardiovascular Surgery (M.E., Y.N.), University of Occupational and Environmental Health, Kitakyushu, Japan; Cardiac Imaging Center, Asan Medical Center Heart Institute, Seoul, South Korea (J.-K.S., J.Y.J., B.J.S., J.K.); Departments of Cardiology (K.M., S.T.) and Cardiovascular Surgery (K.M., S.T.), Sakakibara Heart Institute, Fuchu, Japan; and Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Boston (R.A.L.).
authors.forename: Shota
authors.initials: S
authors.lastname: Fukuda
authors.affiliation: From the Second Department of Internal Medicine (S.F., H.K., T.M., Y.O., S.S., Y.O.), Departments of Laboratory and Transfusion Medicine (M.T.), and Cardiovascular Surgery (M.E., Y.N.), University of Occupational and Environmental Health, Kitakyushu, Japan; Cardiac Imaging Center, Asan Medical Center Heart Institute, Seoul, South Korea (J.-K.S., J.Y.J., B.J.S., J.K.); Departments of Cardiology (K.M., S.T.) and Cardiovascular Surgery (K.M., S.T.), Sakakibara Heart Institute, Fuchu, Japan; and Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Boston (R.A.L.).
authors.forename: Jae-Kwan
authors.initials: JK
authors.lastname: Song
authors.affiliation: From the Second Department of Internal Medicine (S.F., H.K., T.M., Y.O., S.S., Y.O.), Departments of Laboratory and Transfusion Medicine (M.T.), and Cardiovascular Surgery (M.E., Y.N.), University of Occupational and Environmental Health, Kitakyushu, Japan; Cardiac Imaging Center, Asan Medical Center Heart Institute, Seoul, South Korea (J.-K.S., J.Y.J., B.J.S., J.K.); Departments of Cardiology (K.M., S.T.) and Cardiovascular Surgery (K.M., S.T.), Sakakibara Heart Institute, Fuchu, Japan; and Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Boston (R.A.L.).
authors.forename: Keitaro
authors.initials: K
authors.lastname: Mahara
authors.affiliation: From the Second Department of Internal Medicine (S.F., H.K., T.M., Y.O., S.S., Y.O.), Departments of Laboratory and Transfusion Medicine (M.T.), and Cardiovascular Surgery (M.E., Y.N.), University of Occupational and Environmental Health, Kitakyushu, Japan; Cardiac Imaging Center, Asan Medical Center Heart Institute, Seoul, South Korea (J.-K.S., J.Y.J., B.J.S., J.K.); Departments of Cardiology (K.M., S.T.) and Cardiovascular Surgery (K.M., S.T.), Sakakibara Heart Institute, Fuchu, Japan; and Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Boston (R.A.L.).
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kuwaki
authors.affiliation: From the Second Department of Internal Medicine (S.F., H.K., T.M., Y.O., S.S., Y.O.), Departments of Laboratory and Transfusion Medicine (M.T.), and Cardiovascular Surgery (M.E., Y.N.), University of Occupational and Environmental Health, Kitakyushu, Japan; Cardiac Imaging Center, Asan Medical Center Heart Institute, Seoul, South Korea (J.-K.S., J.Y.J., B.J.S., J.K.); Departments of Cardiology (K.M., S.T.) and Cardiovascular Surgery (K.M., S.T.), Sakakibara Heart Institute, Fuchu, Japan; and Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Boston (R.A.L.).
authors.forename: Jeong Yoon
authors.initials: JY
authors.lastname: Jang
authors.affiliation: From the Second Department of Internal Medicine (S.F., H.K., T.M., Y.O., S.S., Y.O.), Departments of Laboratory and Transfusion Medicine (M.T.), and Cardiovascular Surgery (M.E., Y.N.), University of Occupational and Environmental Health, Kitakyushu, Japan; Cardiac Imaging Center, Asan Medical Center Heart Institute, Seoul, South Korea (J.-K.S., J.Y.J., B.J.S., J.K.); Departments of Cardiology (K.M., S.T.) and Cardiovascular Surgery (K.M., S.T.), Sakakibara Heart Institute, Fuchu, Japan; and Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Boston (R.A.L.).
authors.forename: Masaaki
authors.initials: M
authors.lastname: Takeuchi
authors.affiliation: From the Second Department of Internal Medicine (S.F., H.K., T.M., Y.O., S.S., Y.O.), Departments of Laboratory and Transfusion Medicine (M.T.), and Cardiovascular Surgery (M.E., Y.N.), University of Occupational and Environmental Health, Kitakyushu, Japan; Cardiac Imaging Center, Asan Medical Center Heart Institute, Seoul, South Korea (J.-K.S., J.Y.J., B.J.S., J.K.); Departments of Cardiology (K.M., S.T.) and Cardiovascular Surgery (K.M., S.T.), Sakakibara Heart Institute, Fuchu, Japan; and Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Boston (R.A.L.).
authors.forename: Byung Joo
authors.initials: BJ
authors.lastname: Sun
authors.affiliation: From the Second Department of Internal Medicine (S.F., H.K., T.M., Y.O., S.S., Y.O.), Departments of Laboratory and Transfusion Medicine (M.T.), and Cardiovascular Surgery (M.E., Y.N.), University of Occupational and Environmental Health, Kitakyushu, Japan; Cardiac Imaging Center, Asan Medical Center Heart Institute, Seoul, South Korea (J.-K.S., J.Y.J., B.J.S., J.K.); Departments of Cardiology (K.M., S.T.) and Cardiovascular Surgery (K.M., S.T.), Sakakibara Heart Institute, Fuchu, Japan; and Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Boston (R.A.L.).
authors.forename: Yun Jeong
authors.initials: YJ
authors.lastname: Kim
authors.affiliation: From the Second Department of Internal Medicine (S.F., H.K., T.M., Y.O., S.S., Y.O.), Departments of Laboratory and Transfusion Medicine (M.T.), and Cardiovascular Surgery (M.E., Y.N.), University of Occupational and Environmental Health, Kitakyushu, Japan; Cardiac Imaging Center, Asan Medical Center Heart Institute, Seoul, South Korea (J.-K.S., J.Y.J., B.J.S., J.K.); Departments of Cardiology (K.M., S.T.) and Cardiovascular Surgery (K.M., S.T.), Sakakibara Heart Institute, Fuchu, Japan; and Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Boston (R.A.L.).
authors.forename: Tetsu
authors.initials: T
authors.lastname: Miyamoto
authors.affiliation: From the Second Department of Internal Medicine (S.F., H.K., T.M., Y.O., S.S., Y.O.), Departments of Laboratory and Transfusion Medicine (M.T.), and Cardiovascular Surgery (M.E., Y.N.), University of Occupational and Environmental Health, Kitakyushu, Japan; Cardiac Imaging Center, Asan Medical Center Heart Institute, Seoul, South Korea (J.-K.S., J.Y.J., B.J.S., J.K.); Departments of Cardiology (K.M., S.T.) and Cardiovascular Surgery (K.M., S.T.), Sakakibara Heart Institute, Fuchu, Japan; and Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Boston (R.A.L.).
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Oginosawa
authors.affiliation: From the Second Department of Internal Medicine (S.F., H.K., T.M., Y.O., S.S., Y.O.), Departments of Laboratory and Transfusion Medicine (M.T.), and Cardiovascular Surgery (M.E., Y.N.), University of Occupational and Environmental Health, Kitakyushu, Japan; Cardiac Imaging Center, Asan Medical Center Heart Institute, Seoul, South Korea (J.-K.S., J.Y.J., B.J.S., J.K.); Departments of Cardiology (K.M., S.T.) and Cardiovascular Surgery (K.M., S.T.), Sakakibara Heart Institute, Fuchu, Japan; and Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Boston (R.A.L.).
authors.forename: Shinjo
authors.initials: S
authors.lastname: Sonoda
authors.affiliation: From the Second Department of Internal Medicine (S.F., H.K., T.M., Y.O., S.S., Y.O.), Departments of Laboratory and Transfusion Medicine (M.T.), and Cardiovascular Surgery (M.E., Y.N.), University of Occupational and Environmental Health, Kitakyushu, Japan; Cardiac Imaging Center, Asan Medical Center Heart Institute, Seoul, South Korea (J.-K.S., J.Y.J., B.J.S., J.K.); Departments of Cardiology (K.M., S.T.) and Cardiovascular Surgery (K.M., S.T.), Sakakibara Heart Institute, Fuchu, Japan; and Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Boston (R.A.L.).
authors.forename: Masataka
authors.initials: M
authors.lastname: Eto
authors.affiliation: From the Second Department of Internal Medicine (S.F., H.K., T.M., Y.O., S.S., Y.O.), Departments of Laboratory and Transfusion Medicine (M.T.), and Cardiovascular Surgery (M.E., Y.N.), University of Occupational and Environmental Health, Kitakyushu, Japan; Cardiac Imaging Center, Asan Medical Center Heart Institute, Seoul, South Korea (J.-K.S., J.Y.J., B.J.S., J.K.); Departments of Cardiology (K.M., S.T.) and Cardiovascular Surgery (K.M., S.T.), Sakakibara Heart Institute, Fuchu, Japan; and Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Boston (R.A.L.).
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Nishimura
authors.affiliation: From the Second Department of Internal Medicine (S.F., H.K., T.M., Y.O., S.S., Y.O.), Departments of Laboratory and Transfusion Medicine (M.T.), and Cardiovascular Surgery (M.E., Y.N.), University of Occupational and Environmental Health, Kitakyushu, Japan; Cardiac Imaging Center, Asan Medical Center Heart Institute, Seoul, South Korea (J.-K.S., J.Y.J., B.J.S., J.K.); Departments of Cardiology (K.M., S.T.) and Cardiovascular Surgery (K.M., S.T.), Sakakibara Heart Institute, Fuchu, Japan; and Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Boston (R.A.L.).
authors.forename: Shuichiro
authors.initials: S
authors.lastname: Takanashi
authors.affiliation: From the Second Department of Internal Medicine (S.F., H.K., T.M., Y.O., S.S., Y.O.), Departments of Laboratory and Transfusion Medicine (M.T.), and Cardiovascular Surgery (M.E., Y.N.), University of Occupational and Environmental Health, Kitakyushu, Japan; Cardiac Imaging Center, Asan Medical Center Heart Institute, Seoul, South Korea (J.-K.S., J.Y.J., B.J.S., J.K.); Departments of Cardiology (K.M., S.T.) and Cardiovascular Surgery (K.M., S.T.), Sakakibara Heart Institute, Fuchu, Japan; and Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Boston (R.A.L.).
authors.forename: Robert A
authors.initials: RA
authors.lastname: Levine
authors.affiliation: From the Second Department of Internal Medicine (S.F., H.K., T.M., Y.O., S.S., Y.O.), Departments of Laboratory and Transfusion Medicine (M.T.), and Cardiovascular Surgery (M.E., Y.N.), University of Occupational and Environmental Health, Kitakyushu, Japan; Cardiac Imaging Center, Asan Medical Center Heart Institute, Seoul, South Korea (J.-K.S., J.Y.J., B.J.S., J.K.); Departments of Cardiology (K.M., S.T.) and Cardiovascular Surgery (K.M., S.T.), Sakakibara Heart Institute, Fuchu, Japan; and Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Boston (R.A.L.). otsujiy@med.uoeh-u.ac.jp.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Otsuji
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D004452:Echocardiography / Q000379:methods*; D005260:Female; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D007564:Japan; D016018:Least-Squares Analysis; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery; D058386:Mitral Valve Annuloplasty; D008945:Mitral Valve Prolapse / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery; D015999:Multivariate Analysis; D009200:Myocardial Contraction; D015588:Observer Variation; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012307:Risk Factors; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D016277:Ventricular Function, Left
keywords: dilatation; echocardiography; left ventricle; mitral valve; prolapse