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Multicenter Study
. 2022 Jul;35(7):738-751.e1.
doi: 10.1016/j.echo.2022.02.010. Epub 2022 Mar 1.

Three-Dimensional Transthoracic Static and Dynamic Normative Values of the Mitral Valve Apparatus: Results from the Multicenter World Alliance Societies of Echocardiography Study

Michael P Henry  1 , Juan Cotella  1 , Victor Mor-Avi  1 , Karima Addetia  1 , Tatsuya Miyoshi  2 , Marcus Schreckenberg  3 , Michael Blankenhagen  3 , Niklas Hitschrich  3 , Vivekanandan Amuthan  4 , Rodolfo Citro  5 , Masao Daimon  6 , Pedro Gutiérrez-Fajardo  7 , Ravi Kasliwal  8 , James N Kirkpatrick  9 , Mark J Monaghan  10 , Denisa Muraru  11 , Kofo O Ogunyankin  12 , Seung Woo Park  13 , Ana Clara Tude Rodrigues  14 , Ricardo Ronderos  15 , Anita Sadeghpour  16 , Gregory Scalia  17 , Masaaki Takeuchi  18 , Wendy Tsang  19 , Edwin S Tucay  20 , Mei Zhang  21 , Roberto M Lang  22 , Federico M Asch  2
Affiliations
Multicenter Study

Three-Dimensional Transthoracic Static and Dynamic Normative Values of the Mitral Valve Apparatus: Results from the Multicenter World Alliance Societies of Echocardiography Study

Michael P Henry et al. J Am Soc Echocardiogr. 2022 Jul.

Abstract

Background: Recent advances in mitral valve (MV) percutaneous interventions have escalated the need for a more quantitative and comprehensive assessment of the MV, which can be best achieved using three-dimensional echocardiography. Understanding normal valve size, structure, and function is essential for differentiation of healthy from disease states. The aims of this study were to establish normative values for MV apparatus size and morphology and to determine how they vary across age, sex, and race groups using data from the World Alliance Societies of Echocardiography Normal Values Study.

Methods: Three-dimensional volumetric data sets obtained on transthoracic echocardiography in 748 normal subjects (51% men) were analyzed using commercial MV analysis software (TomTec Imaging Systems) to determine annular and leaflet dimensions and areas. The subjects were divided into groups by sex (378 men and 370 women) and age (18 to 40 years [n = 266], 41 to 65 years [n = 249], and >65 years [n = 233]) to identify sex- and age-related differences. In addition, differences among black, white, and Asian populations were studied. Inter- and intraobserver variability was assessed in a subset of 30 subjects and expressed as mean absolute difference between pairs of repeated measurements.

Results: Compared with women, men had larger annular size measurements, larger tenting size parameters, and larger leaflet length and area. Compared with the black and white populations, the Asian population showed significantly smaller mitral annular size. Although many of the age, sex, and race differences in MV parameters were statistically significant, they were comparable with or smaller than the corresponding measurement variability. Indexing to body surface area and height did not eliminate these differences consistently, suggesting that parameters may need to be indexed according to their dimensionality.

Conclusions: This analysis of the World Alliance Societies of Echocardiography data provides normative values of mitral apparatus size and morphology. Although sex- and age-related differences were noted, they need to be interpreted with caution in view of the associated measurement variability.

Keywords: Mitral annulus; Mitral leaflets; Normal values; Three-dimensional echocardiography.

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Figures

Figure 1
Figure 1
Three-dimensional measurements of the MV size and shape parameters (see text for details).
Figure 2
Figure 2
Dynamic measurements of MV parameters throughout systole for the entire study cohort (left) and separately for men (blue) and women (pink; right panels).
See this image and copyright information in PMC

Comment in

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