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Secondary Leaflet Tethering in Patients with degenerative mitral regurgitation and its Association with the Severity of Mitral Regurgitation
  • +12
  • Zhenyi Ge,
  • Chunqiang Hu,
  • Fangyan Tian,
  • Yingjie Zhao,
  • Yongshi Wang,
  • Dehong Kong,
  • Wei Li,
  • Yashu Xie,
  • Zhengdan Ge,
  • zibire fulati,
  • Yufei Cheng,
  • Yao Guo,
  • Yingying Jiang,
  • Cuizhen Pan,
  • Xianhong Shu
Zhenyi Ge
Zhongshan Hospital Fudan University
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Chunqiang Hu
Zhongshan Hospital Fudan University
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Fangyan Tian
Zhongshan Hospital Fudan University
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Yingjie Zhao
Zhongshan Hospital Fudan University
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Yongshi Wang
Zhongshan Hospital Fudan University
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Dehong Kong
Zhongshan Hospital Fudan University
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Wei Li
Zhongshan Hospital Fudan University
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Yashu Xie
ChengDu Healthcare Security Administration
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Zhengdan Ge
Zhongshan Hospital Fudan University
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zibire fulati
Zhongshan Hospital Fudan University
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Yufei Cheng
Zhongshan Hospital Fudan University
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Yao Guo
Zhongshan Hospital Fudan University
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Yingying Jiang
Zhongshan Hospital Fudan University
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Cuizhen Pan
Zhongshan Hospital Fudan University

Corresponding Author:pan.cuizhen@zs-hospital.sh.cn

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Xianhong Shu
Zhongshan Hospital Fudan University
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Abstract

Background The purpose of the study was to determine the association between vena contracta area (VCA) and secondary leaflet tethering among mitral valve prolapse (MVP) patients, and thus to further identify and characterize an MVP with pathological leaflet tethering (MVPt+) phenotype. Methods We prospectively evaluated 94 consecutive MVP patients with significant mitral regurgitation (MR) and 20 healthy controls. MVPt+ group was defined as tenting volume index (TVi) > 0.7 ml/m 2. The three-dimensional (3D) geometry of mitral valve apparatus and VCA was measured with dedicated quantification software. Results Of the 94 patients with MVP and significant MR, 31 patients showed a TVi > 0.7 ml/m 2 and entered the MVP with leaflet tethering (MVPt+) group. In stepwise multivariate analysis, only prolapse volume index and TVi was independently associated with 3D VCA. Apart from marked left ventricular and annular enlargement, MVPt+ group presented significantly higher frequency of leaflet flail, greater VCA, elevated plasma levels of NT-proBNP and sPAP. ROC curve revealed that occurrence of leaflet tethering is associated with a VCA ≥0.55 cm 2 in MVP patients. Conclusions Secondary leaflet tethering is a significant mechanism behind severe degenerative mitral regurgitation, resulting an MVPt+ phenotype featuring more advanced morphological and hemodynamical characteristics .
24 Apr 2023Submitted to Echocardiography
28 Apr 2023Submission Checks Completed
28 Apr 2023Assigned to Editor
01 May 2023Reviewer(s) Assigned
21 May 2023Review(s) Completed, Editorial Evaluation Pending
29 May 2023Editorial Decision: Revise Major
04 Jul 20231st Revision Received
06 Jul 2023Submission Checks Completed
06 Jul 2023Assigned to Editor
06 Jul 2023Reviewer(s) Assigned
11 Jul 2023Review(s) Completed, Editorial Evaluation Pending
16 Jul 2023Editorial Decision: Accept