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Comparative Study
. 2020 Nov-Dec;14(6):502-509.
doi: 10.1016/j.jcct.2020.02.005. Epub 2020 Feb 27.

Dynamic computed tomographic assessment of the mitral annulus in patients with and without mitral prolapse

Asim Rizvi  1 , Roy P Marcus  2 , Yugene Guo  3 , Rickey Carter  4 , Ian T Mark  5 , Thomas A Foley  6 , Nikkole M Weber  7 , Emily N Sheedy  8 , Shuai Leng  9 , Eric E Williamson  10
Affiliations
Comparative Study

Dynamic computed tomographic assessment of the mitral annulus in patients with and without mitral prolapse

Asim Rizvi et al. J Cardiovasc Comput Tomogr. 2020 Nov-Dec.

Abstract

Objectives: To obtain 3D CT measurements of mitral annulus throughout cardiac cycle using prototype mitral modeling software, assess interobserver agreement, and compare among patients with mitral prolapse (MP) and control group.

Background: Pre-procedural imaging is critical for planning of transcatheter mitral valve (MV) replacement. However, there is limited data regarding reliable CT-based measurements to accurately characterize the dynamic geometry of the mitral annulus in patients with MV disease.

Methods: Patients with MP and control subjects without any MV disease who underwent ECG-gated cardiac CT were retrospectively identified. Multiphasic CT data was loaded into a prototype mitral modeling software. Multiple anatomical parameters in 3D space were recorded throughout the cardiac cycle (0-95%): annular circumference, planar-surface-area (PSA), anterior-posterior (A-P) distance, and anterolateral-posteromedial (AL-PM) distance. Comparisons were made among the two groups, with p < 0.05 considered statistically significant. Interobserver agreement was assessed on ten patients using intraclass correlation coefficient (ICC) among 4 experienced readers.

Results: A total of 100 subjects were included: 50 with MP and 50 control. Annular dimensions were significantly higher in the MP group than control group, with circumference (144 ± 11 vs. 117±8 mm), PSA (1533 ± 247 vs. 1005 ± 142 mm2), A-P distance (38 ± 4 vs. 32±2 mm), and AL-PM distance (47 ± 4 vs. 39±3 mm) (all p < 0.001). Substantial size changes were observed throughout the cardiac cycle, but with maximal and minimal sizes at different cardiac phases for the two groups. The interobserver agreement was excellent (ICC≥0.75) for annular circumference, PSA, A-P- and AL-PM distance.

Conclusion: A significant variation in the mitral annular measures between different cardiac phases and two groups was observed with excellent interobserver agreement.

Keywords: Computed tomography angiography; Mitral valve; Mitral valve insufficiency; Mitral valve prolapse; Transcatheter aortic valve replacement.

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Conflict of interest statement

Declaration of competing interest No conflicts of interest are declared.

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