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The influence of chest wall conformation on myocardial strain parameters in a cohort of mitral valve prolapse patients with and without mitral annular disjunction

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Abstract

Purpose

To evaluate the possible influence of chest wall conformation on myocardial strain parameters in a cohort of mitral valve prolapse (MVP) patients with and without mitral annular disjunction (MAD).

Methods

All consecutive middle-aged patients with MVP referred to our Outpatient Cardiology Clinic for performing two-dimensional (2D) transthoracic echocardiography (TTE) as part of work up for primary cardiovascular prevention between March 2018 and May 2022, were included into the study. All patients underwent clinic visit, physical examination, modified Haller index (MHI) assessment (the ratio of chest transverse diameter over the distance between sternum and spine) and conventional 2D-TTE implemented with speckle tracking analysis of left ventricular (LV) global longitudinal strain (GLS) and global circumferential strain (GCS). Independent predictors of MAD presence on 2D-TTE were assessed.

Results

A total of 93 MVP patients (54.2 ± 16.4 yrs, 50.5% females) were prospectively analyzed. On 2D-TTE, 34.4% of MVP patients had MAD (7.3 ± 2.0 mm), whereas 65.6% did not. Compared to patients without MAD, those with MAD had: 1) significantly shorter antero-posterior (A-P) thoracic diameter (13.5 ± 1.2 vs 14.8 ± 1.3 cm, p < 0.001); 2) significantly smaller cardiac chambers dimensions; 3) significantly increased prevalence of classic MVP (84.3 vs 44.3%, p < 0.001); 4) significantly impaired LV-GLS (-17.2 ± 1.4 vs -19.4 ± 3.0%, p < 0.001) and LV-GCS (-16.3 ± 4.1 vs -20.4 ± 4.9, p < 0.001), despite similar LV ejection fraction (63.7 ± 4.2 vs 63.0 ± 3.9%, p = 0.42). A-P thoracic diameter (OR 0.25, 95%CI 0.10–0.82), classic MVP (OR 3.90, 95%CI 1.32–11.5) and mitral annular end-systolic A-P diameter (OR 2.76, 95%CI 1.54–4.92) were the main independent predictors of MAD. An A-P thoracic diameter ≤ 13.5 cm had 59% sensitivity and 84% specificity for predicting MAD presence (AUC = 0.81). In addition, MAD distance was strongly influenced by A-P thoracic diameter (r = − 0.96) and MHI (r = 0.87), but not by L-L thoracic diameter (r = 0.23). Finally, a strong inverse correlation between MHI and both LV-GLS and LV-GCS was demonstrated in MAD patients (r = − 0.94 and − 0.92, respectively), but not in those without (r = − 0.51 and − 0.50, respectively).

Conclusions

A narrow A-P thoracic diameter is strongly associated with MAD presence and is a major determinant of the impairment in myocardial strain parameters in MAD patients, in both longitudinal and circumferential directions.

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Abbreviations

2D:

Two-dimensional

A-P:

Antero-posterior

AUC:

Area under the curve

CIs:

Confidence intervals

CXR:

Chest-X ray

ECG:

Electrocardiogram

EROA:

Effective regurgitant orifice area

GCS:

Global circumferential strain

GLS:

Global longitudinal strain

ICC:

Intraclass correlation coefficient

LAVi:

Left atrial volume index

L-L:

Latero-lateral

LV:

Left ventricular

LVEDDi:

Left ventricular end-diastolic diameter index

LVEF:

Left ventricular ejection fraction

LVMi:

Left ventricular mass index

MAD:

Mitral annular disjunction

MHI:

Modified Haller index

MR:

Mitral regurgitation

MRI:

Magnetic resonance imaging

MVP:

Mitral valve prolapse

NS-STT:

Nonspecific ST-segment and T-wave

NSVT:

Nonsustained ventricular tachycardia

PM:

Papillary muscles

ROC:

Receiver operating characteristics

SPAP:

Systolic pulmonary artery pressure

SD:

Standard deviation

SPB:

Supraventricular premature beats

STE:

Speckle tracking echocardiography

TAPSE:

Tricuspid annular plane systolic excursion

TTE:

Transthoracic echocardiography

VPB:

Ventricular premature beats

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Authors and Affiliations

  1. Division of Cardiology, MultiMedica IRCCS, Via San Vittore 12, 20123, Milan, Italy

    Andrea Sonaglioni, Elisabetta Rigamonti & Michele Lombardo

  2. Division of Cardiology, Policlinico San Giorgio, Pordenone, Italy

    Gian Luigi Nicolosi

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  1. Andrea Sonaglioni
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  2. Gian Luigi Nicolosi
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Contributions

AS: Conceptualization; Data curation; Investigation; Methodology; Software; Visualization; Writing—original draft. ER: Conceptualization; Data curation; Methodology; Writing—review & editing. GLN: Conceptualization; Supervision; Validation; Writing—review & editing. ML: Conceptualization; Supervision; Validation; Writing—review & editing.

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Correspondence to Andrea Sonaglioni.

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The authors declare no competing interests.

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We wish to confirm that there are no conflicts of interest associated with this publication. Andrea Sonaglioni declares that he has no conflict of interest. Gian Luigi Nicolosi declares that he has no conflict of interest. Elisabetta Rigamonti declares that she has no conflict of interest. Michele Lombardo declares that he has no conflicts of interest.

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All procedures performed in the present study were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Sonaglioni, A., Nicolosi, G.L., Rigamonti, E. et al. The influence of chest wall conformation on myocardial strain parameters in a cohort of mitral valve prolapse patients with and without mitral annular disjunction. Int J Cardiovasc Imaging 39, 61–76 (2023). https://doi.org/10.1007/s10554-022-02705-w

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