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Maurice Enriquezsarano - One of the best experts on this subject based on the ideXlab platform.
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presentation and outcome of arrhythmic Mitral Valve Prolapse
Journal of the American College of Cardiology, 2020Co-Authors: Benjamin Essayagh, Avi Sabbag, Clemence Antoine, Giovanni Benfari, Li Tan Yang, Joseph F Maalouf, Samuel J Asirvatham, Hector I Michelena, Maurice EnriquezsaranoAbstract:Abstract Background Mitral Valve Prolapse (MVP) is often considered benign but recent suggestion of an arrhythmic MVP (AMVP) form remains incompletely defined and uncertain. Objectives This study d...
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Mitral Valve Prolapse with mid late systolic Mitral regurgitation pitfalls of evaluation and clinical outcome compared with holosystolic regurgitation
Circulation, 2012Co-Authors: Yan Topilsky, Joseph F Maalouf, Hector I Michelena, Valentina M Bichara, Douglas W Mahoney, Maurice EnriquezsaranoAbstract:Background—Mitral regurgitation (MR) of Mitral Valve Prolapse predominates in late systole but may be holosystolic or purely mid-late systolic, but the impact of MR timing on MR left ventricular and left atrial consequences and outcome is unknown. Whether effective regurgitant orifice (ERO) by the flow convergence method is similarly linked to outcome in mid-late systolic MR and holosystolic MR is uncertain. Methods and Results—We comprehensively and prospectively quantified MR in 111 patients with Mitral Valve Prolapse and mid-late systolic MR and matched them to 90 patients with Mitral Valve Prolapse and holosystolic MR for age, gender, atrial fibrillation, ejection fraction, and ERO (flow convergence). Mid-late systolic MR versus holosystolic MR groups were well matched, including for comorbidity, blood pressure, and heart rate (all P>0.10). Mid-late systolic MR versus holosystolic MR caused similar color jet area, midsystolic regurgitant flow, and peak velocity (P>0.40). Despite identical ERO (0.25±0....
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Mitral Valve Prolapse with mid late systolic Mitral regurgitation pitfalls of evaluation and clinical outcome compared with holosystolic regurgitation
Circulation, 2012Co-Authors: Yan Topilsky, Joseph F Maalouf, Hector I Michelena, Valentina M Bichara, Douglas W Mahoney, Maurice EnriquezsaranoAbstract:Background: Mitral regurgitation (MR) of Mitral Valve Prolapse predominates in late systole but may be holosystolic or purely mid-late systolic, but the impact of MR timing on MR left ventricular and left atrial consequences and outcome is unknown. Whether effective regurgitant orifice (ERO) by the flow convergence method is similarly linked to outcome in mid-late systolic MR and holosystolic MR is uncertain. Methods and results: We comprehensively and prospectively quantified MR in 111 patients with Mitral Valve Prolapse and mid-late systolic MR and matched them to 90 patients with Mitral Valve Prolapse and holosystolic MR for age, gender, atrial fibrillation, ejection fraction, and ERO (flow convergence). Mid-late systolic MR versus holosystolic MR groups were well matched, including for comorbidity, blood pressure, and heart rate (all P>0.10). Mid-late systolic MR versus holosystolic MR caused similar color jet area, midsystolic regurgitant flow, and peak velocity (P>0.40). Despite identical ERO (0.25±0.15 versus 0.25±0.15 cm(2); P=0.53), the shorter duration of mid-late systolic MR (233±56 versus 426±50 ms; P<0.0001) yielded lower regurgitant volume (24.8±13.4 versus 48.6±25.6 mL; P<0.0001). MR consequences, systolic pulmonary pressure, and left ventricular and left atrial volume index (all P<0.001) were more benign in mid-late systolic MR versus holosystolic MR. Under medical management, fewer cardiac events (5 years: 15.8±4.6% versus 40.4±6.1%; P<0.0001) occurred in mid-late systolic MR versus holosystolic MR, requiring less Mitral surgery. Multivariable analysis confirmed the independent association of mid-late systolic MR with benign consequences and outcomes (all P<0.01). Absolute ERO was not linked to outcome, in contrast to regurgitant volume. Conclusions: MR of Mitral Valve Prolapse that is purely mid-late systolic causes more benign consequences and outcomes than holosystolic MR. Assessment may be misleading because jet area and ERO by flow convergence appear similar to those of holosystolic MR. However, shorter MR yields lower regurgitant volume, consequences, and benign outcomes. Instantaneous ERO by flow convergence should be interpreted in context, and in mid-late systolic MR, regurgitant volume provides information more reflective of MR severity. Therefore, for clinical management and surgical referral, clinicians should carefully take into account the timing and consequences of MR.
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sex differences in morphology and outcomes of Mitral Valve Prolapse
Annals of Internal Medicine, 2008Co-Authors: Jeanfrancois Avierinos, Jocelyn Inamo, Francesco Grigioni, Bernard J Gersh, Clarence Shub, Maurice EnriquezsaranoAbstract:Mitral Valve Prolapse is more common in women than in men, but men more frequently undergo surgery for severe Mitral regurgitation. Avierinos and colleagues sought to determine the reason for these...
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risk determinants and outcome implications of progression of Mitral regurgitation after diagnosis of Mitral Valve Prolapse in a single community
American Journal of Cardiology, 2008Co-Authors: Jeanfrancois Avierinos, Delphine Detaint, D Messikazeitoun, Dania Mohty, Maurice EnriquezsaranoAbstract:To analyze the evolution of Mitral regurgitation (MR) after the diagnosis of Mitral Valve Prolapse in community patients, 285 residents of Olmsted County, Minnesota, diagnosed with Mitral Valve Prolapse without severe MR were studied. MR grade was assessed at diagnosis and at follow-up 1,663 ± 1,079 days later using Doppler echocardiography. The progression of MR was defined as an increase of ≥1 MR grade. The patients’ mean age was 56 ± 22 years, 57% were women, and the mean ejection fraction was 60 ± 9%. Between diagnostic and follow-up echocardiography, 108 patients showed progression of MR, 39 of whom had progression ≥1 grade. The mean overall MR grade increased from 0.4 ± 0.7 to 0.9 ± 1.1 (p
Robert A Levine - One of the best experts on this subject based on the ideXlab platform.
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myocardial strain pattern and history of atrial fibrillation are associated with the risk of ventricular arrhythmias in Mitral Valve Prolapse
Journal of the American College of Cardiology, 2020Co-Authors: Kristian Ujka, Robert A Levine, Yasufumi Nagata, Philippe Bertrand, Carl T Andrews, Michael H Picard, Judy HungAbstract:Risk stratification for arrhythmic Mitral Valve Prolapse (MVP) remains challenging. This study aims to assess whether baseline clinical and echocardiographic variables including left ventricle global (LVGLS) and regional longitudinal strain (RLS) are associated to ventricular arrhythmia (VA) in
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Mitral Valve Prolapse multimodality imaging and genetic insights
Progress in Cardiovascular Diseases, 2017Co-Authors: Purvi Parwani, Jeanfrancois Avierinos, Robert A Levine, Francesca N DellingAbstract:Mitral Valve Prolapse (MVP) is a common heritable valvulopathy affecting approximately 2.4% of the population. It is the most important cause of primary Mitral regurgitation (MR) requiring surgery. MVP is characterized by fibromyxomatous changes and displacement of one or both Mitral leaflets into the left atrium. Echocardiography represents the primary diagnostic modality for assessment of MVP. Accurate quantitation of ventricular volumes and function for surgical planning in asymptomatic severe MR can be provided with both echocardiography and cardiac magnetic resonance. In addition, assessment of myocardial fibrosis using late gadolinium enhancement and T1 mapping allows better understanding of the impact of MVP on the myocardium. Imaging in MVP is important not only for diagnostic and prognostic purposes, but is also essential for detailed phenotyping in genetic studies. Genotype-phenotype studies in MVP pedigrees have allowed the identification of milder, non-diagnostic MVP morphologies by echocardiography. Such morphologies represent early expression of MVP in gene carriers. This review focuses on multimodality imaging and the phenotypic spectrum of MVP. Moreover, the review details the recent genetic discoveries that have increased our understanding of the pathophysiology of MVP, with clues to mechanisms and therapy.
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abstract 14210 gwas driven pathway analyses and functional validation reveals glis1 predisposes to Mitral Valve Prolapse
Circulation, 2016Co-Authors: Christian Dina, Robert A Levine, Francesca N Delling, Nathan R Tucker, Susan A Slaugenhaupt, Albert Hagege, Jeanjacques Schott, Xavier Jeunemaitre, David J Milan, Russell NorrisAbstract:Introduction: Mitral Valve Prolapse (MVP) is the most common indication for surgical repair of Mitral regurgitation. Our genome-wide association study (GWAS) had identified 6 risk loci for MVP. Hyp...
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response to letter regarding article familial clustering of Mitral Valve Prolapse in the community
Circulation, 2015Co-Authors: Francesca N Delling, Robert A Levine, Martin G Larson, Birgitta T Lehman, Emelia J Benjamin, Jian Rong, Ewa Osypiuk, Plamen Stantchev, Susan A Slaugenhaupt, Ramachandran S VasanAbstract:We thank Dr Barison and colleagues for their interest in our article.1 In our manuscript, we demonstrate that both parental Mitral Valve Prolapse (MVP) and parental mild, nondiagnostic MVP are associated with increased prevalence of MVP in the offspring in the Framingham Heart Study community. In their letter, Barison et al underline the importance of age when assessing MVP prevalence, stating that MVP is more common among older participants in the offspring or generation 2 (Gen 2) than in the younger generation 3 (Gen 3). Based on published Framingham Heart Study literature,2 the prevalence of MVP in Gen 2 is 2.4% at their fifth examination cycle. This percentage is slightly higher in the same cohort at their sixth examination cycle (98/3380 or 2.9%) and at their eighth examination cycle (94/2725 or 3.4%; ie, 11 to 17 years …
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familial clustering of Mitral Valve Prolapse in the community
Circulation, 2015Co-Authors: Francesca N Delling, Robert A Levine, Martin G Larson, Birgitta T Lehman, Emelia J Benjamin, Jian Rong, Ewa Osypiuk, Plamen Stantchev, Susan A Slaugenhaupt, Ramachandran S VasanAbstract:Background—Knowledge of Mitral Valve Prolapse (MVP) inheritance is based on pedigree observation and M-mode echocardiography. The extent of familial clustering of MVP among unselected individuals in the community using current, more specific echocardiographic criteria is unknown. In addition, the importance of nondiagnostic MVP morphologies (NDMs; first described in large pedigrees) has not been investigated in the general population. We hypothesized that parental MVP and NDMs increase the risk of offspring MVP. Methods and Results—Study participants were 3679 Generation 3 individuals with available parental data in the Offspring or the New Offspring Spouse cohorts. MVP and NDMs were distinguished by leaflet displacement >2 versus ≤2 mm beyond the Mitral annulus, respectively. We compared MVP prevalence in Generation 3 participants with at least 1 parent with MVP (n=186) with that in individuals without parental MVP (n=3493). Among 3679 participants (53% women; mean age, 40±9 years), 49 (1%) had MVP. Pare...
Susan B Yeon - One of the best experts on this subject based on the ideXlab platform.
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evaluation of papillary muscle function using cardiovascular magnetic resonance imaging in Mitral Valve Prolapse
American Journal of Cardiology, 2010Co-Authors: Dana C Peters, Warren J Manning, Beth Goddu, Kraig V Kissinger, Susan B Yeon, Reza NezafatAbstract:Abnormal traction and excursion of the papillary muscle (PM) can be observed in patients with Mitral Valve Prolapse (MVP) and can adversely affect the electrophysiologic stability of the underlying myocardium. Cardiovascular magnetic resonance (CMR) techniques can directly measure the excursion and velocity of PM tips during ventricular systole. In addition, high-resolution late gadolinium enhancement (LGE) CMR imaging allows for visualization of the underlying potentially arrhythmogenic PM fibrosis substrate. We prospectively studied 16 patients with MVP and 9 healthy adult subjects using phase-contrast CMR and cine CMR to assess the PM velocity and excursion. LGE CMR was performed in 13 patients with MVP (81%). The peak PM systolic velocity and maximum PM excursion were significantly increased in those with MVP (12 ± 5 vs 5 ± 2 cm/s and 15 ± 5 vs 2 ± 3 mm, both p
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cardiovascular magnetic resonance characterization of Mitral Valve Prolapse
Jacc-cardiovascular Imaging, 2008Co-Authors: Yuchi Han, Warren J Manning, Dana C Peters, Carol J Salton, Dorota Bzymek, Reza Nezafat, Beth Goddu, Kraig V Kissinger, Peter Zimetbaum, Susan B YeonAbstract:Objectives This study sought to develop cardiovascular magnetic resonance (CMR) diagnostic criteria for Mitral Valve Prolapse (MVP) using echocardiography as the gold standard and to characterize MVP using cine CMR and late gadolinium enhancement (LGE)-CMR. Background Mitral Valve Prolapse is a common valvular heart disease with significant complications. Cardiovascular magnetic resonance is a valuable imaging tool for assessing ventricular function, quantifying regurgitant lesions, and identifying fibrosis, but its potential role in evaluating MVP has not been defined. Methods To develop CMR diagnostic criteria for MVP, characterize Mitral Valve morphology, we analyzed transthoracic echocardiography and cine CMR images from 25 MVP patients and 25 control subjects. Leaflet thickness, length, Mitral annular diameters, and Prolapsed distance were measured. Two- and three-dimensional LGE-CMR images were obtained in 16 MVP and 10 control patients to identify myocardial regions of fibrosis in MVP. Results We found that a 2-mm threshold for leaflet excursion into the left atrium in the left ventricular outflow tract long-axis view yielded 100% sensitivity and 100% specificity for CMR using transthoracic echocardiography as the clinical gold standard. Compared with control subjects, CMR identified MVP patients as having thicker (3.2 ± 0.1 mm vs. 2.3 ± 0.1 mm) and longer (10.5 ± 0.5 mm/m 2 vs. 7.1 ± 0.3 mm/m 2 ) indexed posterior leaflets and larger indexed Mitral annular diameters (27.8 ± 0.7 mm/m 2 vs. 21.5 ± 0.5 mm/m 2 for long axis and 22.9 ±0.7 mm/m 2 vs. 17.8 ± 0.6 mm/m 2 for short axis). In addition, we identified focal regions of LGE in the papillary muscles suggestive of fibrosis in 10 (63%) of 16 MVP patients and in 0 of 10 control subjects. Papillary muscle LGE was associated with the presence of complex ventricular arrhythmias in MVP patients. Conclusions Cardiovascular magnetic resonance image can identify MVP by the same echocardiographic criteria and can identify myocardial fibrosis involving the papillary muscle in MVP patients. Hyperenhancement of papillary muscles on LGE is often present in a subgroup of patients with complex ventricular arrhythmias.
Warren J Manning - One of the best experts on this subject based on the ideXlab platform.
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evolution of Mitral Valve Prolapse insights from the framingham heart study
Circulation, 2016Co-Authors: Francesca N Delling, Martin G Larson, Deborah L Fuller, Birgitta T Lehman, Jian Rong, Ewa Osypiuk, Plamen Stantchev, Brianne Hackman, Warren J Manning, Emelia J BenjaminAbstract:Background—Longitudinal studies of Mitral Valve Prolapse (MVP) progression among unselected individuals in the community, including those with nondiagnostic MVP morphologies (NDMs), are lacking. Me...
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evaluation of papillary muscle function using cardiovascular magnetic resonance imaging in Mitral Valve Prolapse
American Journal of Cardiology, 2010Co-Authors: Dana C Peters, Warren J Manning, Beth Goddu, Kraig V Kissinger, Susan B Yeon, Reza NezafatAbstract:Abnormal traction and excursion of the papillary muscle (PM) can be observed in patients with Mitral Valve Prolapse (MVP) and can adversely affect the electrophysiologic stability of the underlying myocardium. Cardiovascular magnetic resonance (CMR) techniques can directly measure the excursion and velocity of PM tips during ventricular systole. In addition, high-resolution late gadolinium enhancement (LGE) CMR imaging allows for visualization of the underlying potentially arrhythmogenic PM fibrosis substrate. We prospectively studied 16 patients with MVP and 9 healthy adult subjects using phase-contrast CMR and cine CMR to assess the PM velocity and excursion. LGE CMR was performed in 13 patients with MVP (81%). The peak PM systolic velocity and maximum PM excursion were significantly increased in those with MVP (12 ± 5 vs 5 ± 2 cm/s and 15 ± 5 vs 2 ± 3 mm, both p
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cardiovascular magnetic resonance characterization of Mitral Valve Prolapse
Jacc-cardiovascular Imaging, 2008Co-Authors: Yuchi Han, Warren J Manning, Dana C Peters, Carol J Salton, Dorota Bzymek, Reza Nezafat, Beth Goddu, Kraig V Kissinger, Peter Zimetbaum, Susan B YeonAbstract:Objectives This study sought to develop cardiovascular magnetic resonance (CMR) diagnostic criteria for Mitral Valve Prolapse (MVP) using echocardiography as the gold standard and to characterize MVP using cine CMR and late gadolinium enhancement (LGE)-CMR. Background Mitral Valve Prolapse is a common valvular heart disease with significant complications. Cardiovascular magnetic resonance is a valuable imaging tool for assessing ventricular function, quantifying regurgitant lesions, and identifying fibrosis, but its potential role in evaluating MVP has not been defined. Methods To develop CMR diagnostic criteria for MVP, characterize Mitral Valve morphology, we analyzed transthoracic echocardiography and cine CMR images from 25 MVP patients and 25 control subjects. Leaflet thickness, length, Mitral annular diameters, and Prolapsed distance were measured. Two- and three-dimensional LGE-CMR images were obtained in 16 MVP and 10 control patients to identify myocardial regions of fibrosis in MVP. Results We found that a 2-mm threshold for leaflet excursion into the left atrium in the left ventricular outflow tract long-axis view yielded 100% sensitivity and 100% specificity for CMR using transthoracic echocardiography as the clinical gold standard. Compared with control subjects, CMR identified MVP patients as having thicker (3.2 ± 0.1 mm vs. 2.3 ± 0.1 mm) and longer (10.5 ± 0.5 mm/m 2 vs. 7.1 ± 0.3 mm/m 2 ) indexed posterior leaflets and larger indexed Mitral annular diameters (27.8 ± 0.7 mm/m 2 vs. 21.5 ± 0.5 mm/m 2 for long axis and 22.9 ±0.7 mm/m 2 vs. 17.8 ± 0.6 mm/m 2 for short axis). In addition, we identified focal regions of LGE in the papillary muscles suggestive of fibrosis in 10 (63%) of 16 MVP patients and in 0 of 10 control subjects. Papillary muscle LGE was associated with the presence of complex ventricular arrhythmias in MVP patients. Conclusions Cardiovascular magnetic resonance image can identify MVP by the same echocardiographic criteria and can identify myocardial fibrosis involving the papillary muscle in MVP patients. Hyperenhancement of papillary muscles on LGE is often present in a subgroup of patients with complex ventricular arrhythmias.
Reza Nezafat - One of the best experts on this subject based on the ideXlab platform.
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evaluation of papillary muscle function using cardiovascular magnetic resonance imaging in Mitral Valve Prolapse
American Journal of Cardiology, 2010Co-Authors: Dana C Peters, Warren J Manning, Beth Goddu, Kraig V Kissinger, Susan B Yeon, Reza NezafatAbstract:Abnormal traction and excursion of the papillary muscle (PM) can be observed in patients with Mitral Valve Prolapse (MVP) and can adversely affect the electrophysiologic stability of the underlying myocardium. Cardiovascular magnetic resonance (CMR) techniques can directly measure the excursion and velocity of PM tips during ventricular systole. In addition, high-resolution late gadolinium enhancement (LGE) CMR imaging allows for visualization of the underlying potentially arrhythmogenic PM fibrosis substrate. We prospectively studied 16 patients with MVP and 9 healthy adult subjects using phase-contrast CMR and cine CMR to assess the PM velocity and excursion. LGE CMR was performed in 13 patients with MVP (81%). The peak PM systolic velocity and maximum PM excursion were significantly increased in those with MVP (12 ± 5 vs 5 ± 2 cm/s and 15 ± 5 vs 2 ± 3 mm, both p
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cardiovascular magnetic resonance characterization of Mitral Valve Prolapse
Jacc-cardiovascular Imaging, 2008Co-Authors: Yuchi Han, Warren J Manning, Dana C Peters, Carol J Salton, Dorota Bzymek, Reza Nezafat, Beth Goddu, Kraig V Kissinger, Peter Zimetbaum, Susan B YeonAbstract:Objectives This study sought to develop cardiovascular magnetic resonance (CMR) diagnostic criteria for Mitral Valve Prolapse (MVP) using echocardiography as the gold standard and to characterize MVP using cine CMR and late gadolinium enhancement (LGE)-CMR. Background Mitral Valve Prolapse is a common valvular heart disease with significant complications. Cardiovascular magnetic resonance is a valuable imaging tool for assessing ventricular function, quantifying regurgitant lesions, and identifying fibrosis, but its potential role in evaluating MVP has not been defined. Methods To develop CMR diagnostic criteria for MVP, characterize Mitral Valve morphology, we analyzed transthoracic echocardiography and cine CMR images from 25 MVP patients and 25 control subjects. Leaflet thickness, length, Mitral annular diameters, and Prolapsed distance were measured. Two- and three-dimensional LGE-CMR images were obtained in 16 MVP and 10 control patients to identify myocardial regions of fibrosis in MVP. Results We found that a 2-mm threshold for leaflet excursion into the left atrium in the left ventricular outflow tract long-axis view yielded 100% sensitivity and 100% specificity for CMR using transthoracic echocardiography as the clinical gold standard. Compared with control subjects, CMR identified MVP patients as having thicker (3.2 ± 0.1 mm vs. 2.3 ± 0.1 mm) and longer (10.5 ± 0.5 mm/m 2 vs. 7.1 ± 0.3 mm/m 2 ) indexed posterior leaflets and larger indexed Mitral annular diameters (27.8 ± 0.7 mm/m 2 vs. 21.5 ± 0.5 mm/m 2 for long axis and 22.9 ±0.7 mm/m 2 vs. 17.8 ± 0.6 mm/m 2 for short axis). In addition, we identified focal regions of LGE in the papillary muscles suggestive of fibrosis in 10 (63%) of 16 MVP patients and in 0 of 10 control subjects. Papillary muscle LGE was associated with the presence of complex ventricular arrhythmias in MVP patients. Conclusions Cardiovascular magnetic resonance image can identify MVP by the same echocardiographic criteria and can identify myocardial fibrosis involving the papillary muscle in MVP patients. Hyperenhancement of papillary muscles on LGE is often present in a subgroup of patients with complex ventricular arrhythmias.