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Echocardiography (Mount Kisco, N.Y.) Aug 2019Mitral annular disjunction (MAD) is a structural abnormality where there is a separation between the mitral valve annulus and the left atrial wall which is not well...
BACKGROUND
Mitral annular disjunction (MAD) is a structural abnormality where there is a separation between the mitral valve annulus and the left atrial wall which is not well understood.
METHODS
We conducted a systematic review to evaluate the prevalence of MAD, factors associated with MAD and clinical outcomes among patients with MAD.
RESULTS
A total of 19 studies were included in this review, and the number of noncase report studies had between 23 and 1439 patients. The pooled rate of MAD in studies of myxomatous mitral valve patients was 66/130 (50.8%, 3 studies), and among patients with mitral valve prolapse was 95/291 (32.6%, 3 studies). One study suggests that 78% of patients with MAD had mitral valve prolapse, and another suggested it was strongly associated with myxomatous mitral valve disease (HR 5.04 95% CI 1.66-15.31). In terms of clinical significance, it has been reported that MAD with disjunction > 8.5 mm was associated with nonsustained ventricular tachycardia (OR 10 95% CI 1.28-78.1). There is also evidence that gadolinium enhancement in papillary muscle (OR 4.09 95% CI 1.28-13.05) and longitudinal MAD distance in posterolateral wall (OR 1.16 95% CI 1.02-1.33) was predictive of ventricular arrhythmia and late gadolinium enhancement in anterolateral papillary muscle was strongly associated with serious arrhythmic event (OR 7.35 95% CI 1.15-47.02).
CONCLUSIONS
Mitral annular disjunction appears to be common in myxomatous mitral valve disease and mitral valve prolapse which can be detected on cardiac imaging and may be important because of its association with ventricular arrhythmias and sudden cardiac death.
Topics: Echocardiography; Heart Defects, Congenital; Heart Valve Diseases; Humans; Mitral Valve
PubMed: 31385360
DOI: 10.1111/echo.14437 -
Heart (British Cardiac Society) Jan 2019Mitral valve prolapse (MVP) is commonly observed as a benign finding. However, the literature suggests that it may be associated with sudden cardiac death (SCD). We... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
Mitral valve prolapse (MVP) is commonly observed as a benign finding. However, the literature suggests that it may be associated with sudden cardiac death (SCD). We performed a meta-analysis and systematic review to determine the: (1) prevalence of MVP in the general population; (2) prevalence of MVP in all SCD and unexplained SCD; (3) incidence of SCD in MVP and (4) risk factors for SCD.
METHODS
The English medical literature was searched for: (1) MVP community prevalence; (2) MVP prevalence in SCD cohorts; (3) incidence SCD in MVP and (4) SCD risk factors in MVP. Thirty-four studies were identified for inclusion. This study was registered with PROSPERO (CRD42018089502).
RESULTS
The prevalence of MVP was 1.2% (95% CI 0.5 to 2.0) in community populations. Among SCD victims, the cause of death remained undetermined in 22.1% (95% CI 13.4 to 30.7); of these, MVP was observed in 11.7% (95% CI 5.8 to 19.1). The incidence of SCD in the MVP population was 0.14% (95% CI 0.1 to 0.3) per year. Potential risk factors for SCD include bileaflet prolapse, ventricular fibrosis complex ventricular ectopy and ST-T wave abnormalities.
CONCLUSION
The high prevalence of MVP in cohorts of unexplained SCD despite low population prevalence provides indirect evidence of an association of MVP with SCD. The absolute number of people exposed to the risk of SCD is significant, although the incidence of life-threatening arrhythmic events in the general MVP population remains low. High-risk features include bileaflet prolapse, ventricular fibrosis, ST-T wave abnormalities and frequent complex ventricular ectopy.
TRIAL REGISTRATION
PROSPERO (CRD42018089502).
Topics: Death, Sudden, Cardiac; Echocardiography; Global Health; Heart Ventricles; Humans; Incidence; Mitral Valve Prolapse; Risk Factors; Survival Rate
PubMed: 30242141
DOI: 10.1136/heartjnl-2017-312932 -
Catheterization and Cardiovascular... Jul 2023Left circumflex coronary artery (LCx) injury related to mitral valve surgery is a rare complication. The best treatment option is not defined, and percutaneous coronary... (Review)
Review
Left circumflex coronary artery (LCx) injury related to mitral valve surgery is a rare complication. The best treatment option is not defined, and percutaneous coronary intervention (PCI) may represent an effective treatment to avoid prolonged myocardial ischemia. To evaluate feasibility and efficacy of PCI treatment, all records of LCx injury related to mitral valve surgery and treated with PCI were included after a systematic PubMed searching. Moreover, we retrospectively analyzed our single-center PCI database and patients fulfilling the inclusion criteria were included. Patients undergoing transcatheter mitral valve intervention, non-mitral valve surgery, conservatively or surgically treated after LCx injury were excluded. Data about patient characteristics, procedural details, PCI success, and in-hospital mortality were collected. Fifty-six patients were included, 58.9% were male (n = 33) and the median age was 60.5 years (IQR = 21.75). The majority had left dominant or codominant coronary system (62.2%, n = 28 and 15.6%, n = 7, respectively). Clinical manifestations ranged from hemodynamic stability (21.1%, n = 8) to hemodynamic instability (42.1%, n = 16) and cardiac arrest (18.4%, n = 7). On ECG, 23.5% of patients (n = 12) presented ST-segment depression, 58.8% (n = 30) ST-segment elevation, 7.8% (n = 4) atrioventricular block, and 29.4% (n = 15) ventricular arrhythmias. Left ventricle dysfunction was present in 52.3% (n = 22) of patients and wall motion abnormalities in 71.4% (n = 30). PCI success rate was 82.1% (n = 46) and in-hospital mortality 4.5% (n = 2). LCx injury related to mitral surgery is a rare complication characterized by an increased risk of mortality. PCI seems a feasible treatment option, still burdened by suboptimal results, probably related to the technical challenges posed by the surgical failure.
Topics: Humans; Male; Middle Aged; Female; Coronary Vessels; Percutaneous Coronary Intervention; Treatment Outcome; Retrospective Studies; Mitral Valve
PubMed: 37210617
DOI: 10.1002/ccd.30693 -
Cardiology in the Young Sep 2023Double-orifice mitral valve or left atrioventricular valve is a rare congenital cardiac anomaly that may be associated with an atrioventricular septal defect. The... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Double-orifice mitral valve or left atrioventricular valve is a rare congenital cardiac anomaly that may be associated with an atrioventricular septal defect. The surgical management of double-orifice mitral valve/double-orifice left atrioventricular valve with atrioventricular septal defect is highly challenging with acceptable clinical outcomes. This meta-analysis is aimed to evaluate the surgical outcomes of double-orifice mitral valve/double-orifice left atrioventricular valve repair in patients with atrioventricular septal defect.
METHODS AND RESULTS
A total of eight studies were retrieved from the literature by searching through PubMed, Google Scholar, Embase, and Cochrane databases. Using Bayesian hierarchical models, we estimated the pooled proportion of incidence of double-orifice mitral valve/double-orifice left atrioventricular valve with atrioventricular septal defect as 4.88% in patients who underwent surgical repair (7 studies; 3295 patients; 95% credible interval [CI] 4.2-5.7%). As compared to pre-operative regurgitation, the pooled proportions of post-operative regurgitation were significantly low in patients with moderate status: 5.1 versus 26.39% and severe status: 5.7 versus 29.38% [8 studies; 171 patients]. Moreover, the heterogeneity test revealed consistency in the data (p < 0.05). Lastly, the pooled estimated proportions of early and late mortality following surgical interventions were low, that is, 5 and 7.4%, respectively.
CONCLUSION
The surgical management of moderate to severe regurgitation showed corrective benefits post-operatively and was associated with low incidence of early mortality and re-operation.
Topics: Humans; Infant; Mitral Valve; Bayes Theorem; Heart Septal Defects; Heart Defects, Congenital; Mitral Valve Insufficiency; Reoperation; Treatment Outcome
PubMed: 37518865
DOI: 10.1017/S1047951123002664 -
Journal of Cardiothoracic Surgery Mar 2010Libman-Sacks endocarditis of the mitral valve was first described by Libman and Sacks in 1924. Currently, the sterile verrucous vegetative lesions seen in Libman-Sacks... (Review)
Review
Libman-Sacks endocarditis of the mitral valve was first described by Libman and Sacks in 1924. Currently, the sterile verrucous vegetative lesions seen in Libman-Sacks endocarditis are regarded as a cardiac manifestation of both systemic lupus erythematosus (SLE) and the antiphospholipid syndrome (APS). Although typically mild and asymptomatic, complications of Libman-Sacks endocarditis may include superimposed bacterial endocarditis, thromboembolic events, and severe valvular regurgitation and/or stenosis requiring surgery. In this study we report two cases of mitral valve repair and two cases of mitral valve replacement for mitral regurgitation (MR) caused by Libman-Sacks endocarditis. In addition, we provide a systematic review of the English literature on mitral valve surgery for MR caused by Libman-Sacks endocarditis. This report shows that mitral valve repair is feasible and effective in young patients with relatively stable SLE and/or APS and only localized mitral valve abnormalities caused by Libman-Sacks endocarditis. Both clinical and echocardiographic follow-up after repair show excellent mid- and long-term results.
Topics: Adult; Antiphospholipid Syndrome; Echocardiography; Female; Heart Valve Prosthesis Implantation; Humans; Lupus Erythematosus, Systemic; Male; Middle Aged; Mitral Valve; Mitral Valve Insufficiency
PubMed: 20331896
DOI: 10.1186/1749-8090-5-13 -
Pacing and Clinical Electrophysiology :... May 2022As the established surgical mitral valve replacement (MVR) expands toward various contemporary techniques and access routes, the predictors and burden of... (Review)
Review
As the established surgical mitral valve replacement (MVR) expands toward various contemporary techniques and access routes, the predictors and burden of procedure-related complications including the need for permanent pacemaker (PPM) implantation need to be identified. Digital databases were searched systematically to identify studies reporting the incidence of PPM implantation after MVR. Detailed study and patient-level baseline characteristics including the type of study, sample size, follow-up, number of post-MVR PPM implantations, age, gender, and baseline ECG abnormalities were abstracted. A total of 12 studies, recruiting 37,124 patients were included in the final analysis. Overall, 2820 (7.6%) patients required a PPM with the net rate ranging from 1.7% to 10.96%. Post-MVR atrioventricular (AV) block was the most commonly observed indication for PPM, followed by sinoatrial (SA) node dysfunction, and bradycardia. Age, male gender, pre-existing comorbid conditions, prior CABG, history of arrhythmias or using antiarrhythmic drugs, atrial fibrillation ablation, and double valve replacement were predictors of PPM implantation post-MVR. Age, male gender, comorbid conditions like diabetes and renal impairment, prior CABG, double valve replacement, and antiarrhythmic drugs served as positive predictors of PPM implantation in patients undergoing MVR.
Topics: Anti-Arrhythmia Agents; Aortic Valve Stenosis; Atrial Fibrillation; Atrioventricular Block; Humans; Male; Mitral Valve; Pacemaker, Artificial; Postoperative Complications; Retrospective Studies; Risk Factors; Sick Sinus Syndrome; Transcatheter Aortic Valve Replacement; Treatment Outcome
PubMed: 35304920
DOI: 10.1111/pace.14484 -
Health Technology Assessment... Mar 2014Identification of the underlying cause of stroke and transient ischaemic attack (TIA) is important so that preventative therapy can be used to reduce the risk of... (Review)
Review
BACKGROUND
Identification of the underlying cause of stroke and transient ischaemic attack (TIA) is important so that preventative therapy can be used to reduce the risk of recurrence. Transthoracic echocardiography (TTE) and transoesophageal echocardiography (TOE) are diagnostic tools used to identify those cardiac sources of stroke that may respond to treatment.
OBJECTIVES
(1) Undertake systematic reviews to determine (a) the prevalence of cardiac sources of stroke and TIA and (b) the diagnostic accuracy of echocardiography; (2) undertake a survey to ascertain which guidelines and management strategies are used by UK stroke centres; and (3) evaluate the cost-effectiveness of the addition of TTE to the routine assessment of patients who have had a first-episode diagnosed stroke or TIA in the UK.
DATA SOURCES
Bibliographic databases including MEDLINE, EMBASE, the Cumulative Index to Nursing and Allied Health Literature, PsycINFO and the NHS Economic Evaluation Database were searched from inception to December 2010 (prevalence) or September 2011 (diagnostic accuracy). Bibliographies of related papers were screened and experts were contacted to identify additional published and unpublished references.
REVIEW METHODS
The systematic reviews were undertaken according to the general principles recommended in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. A decision-analytic model was developed to estimate the costs and quality-adjusted life-years accrued by each potential echocardiography strategy in the management of stroke and TIA for patients aged 45, 55 and 65 years. The model took a lifetime horizon and a NHS perspective. Costs and health benefits were discounted at an annual rate of 3.5%. Evidence to enable modelling was found for left atrial thrombus only. The cost-effectiveness of echocardiography is therefore based on all stroke patients being tested but only those with a left atrial thrombus receiving the benefits and harms of treatment. To describe current NHS stroke management practice we provided a questionnaire to the lead clinician of all stroke units in the UK.
RESULTS
The searches identified 17,278 citations for the systematic review of the prevalence of potential cardiac sources of stroke and TIA, of which 65 studies were included. Patent foramen ovale was the most frequently reported pathology, followed by atrial septal aneurysm and mitral valve prolapse, with prevalence ranging from 0.25% to 73%, from 0.4% to 28% and from 0% to 31.6% respectively. For the systematic review of the diagnostic accuracy of echocardiography, 16,504 citations were identified, of which 51 studies were included. The pooled sensitivity to detect left atrial thrombus in three studies using transthoracic echocardiography in second harmonic imaging mode (TTEh) was 0.79 [95% credible interval (CrI) 0.47 to 0.94], with a pooled specificity of 1.00 (95% CrI 0.99 to 1.00) compared with TOE. Differences in the diagnostic accuracy of tests occurred mostly in their sensitivity to detect cardiac sources of stroke. No adverse events data were reported. Our principal economic finding is that TTEh is a cost-effective use of NHS resources compared with TOE when clinicians deem it the most appropriate test. The survey showed that the decision-making process for the management of stroke and TIA is very complex and varies considerably by site. It is clear that to accurately describe current management practice a very sophisticated questionnaire would be required.
LIMITATIONS
The prevalence review highlights the difficulties that clinicians face when identifying the cause of cardioembolic stroke (the limitations of the tests, the confounding comorbidities and the inherent mobility of blood clots). The diagnostic accuracy review was limited by the small number of studies reporting data or because studies included too few participants with a cardiac pathology, leaving a large degree of uncertainty about the underlying diagnostic accuracy. The economic model has limitations because of the limited data available for important parameters such as the efficacy of treatment in reducing stroke recurrence.
CONCLUSION
The economic analysis indicates that, in those cases in which TTEh is deemed the most appropriate test, it is a cost-effective use of NHS resources. However, this analysis has highlighted a lack of evidence in several areas and the results of the economic evaluation should therefore be treated with caution. There is a need for further evaluation of current echocardiography technologies, the causal associations between potential risk factors and stroke and whether or not anticoagulation therapies prevent recurrent stroke. Studies attempting to establish the prevalence of cardiac sources of stroke should identify all potential risk factors, rule out those that are not relevant and grade the findings according to risk. Research is also needed to reduce the uncertainty around the estimates of the sensitivity and specificity of TTEh and TOE, singly and in combination, in detecting treatable cardiac abnormalities compared with the 'gold standard' in each pathology.
STUDY REGISTRATION
The study is registered as PROSPERO no. CRD42011001353.
FUNDING
The National Institute for Health Research Health Technology Assessment programme.
Topics: Aged; Cost-Benefit Analysis; Echocardiography; Humans; Ischemic Attack, Transient; Middle Aged; Stroke Rehabilitation; Technology Assessment, Biomedical
PubMed: 24602782
DOI: 10.3310/hta18160 -
Frontiers in Endocrinology 2023Although subclinical hypothyroidism (SCH) is related to abnormalities in left ventricular diastolic function, the use of levothyroxine as a regular treatment remains... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Although subclinical hypothyroidism (SCH) is related to abnormalities in left ventricular diastolic function, the use of levothyroxine as a regular treatment remains debatable. This meta-analysis aimed to determine whether thyroid hormone replacement therapy affects cardiac diastolic function in patients with SCH as measured by echocardiography.
METHODS
This meta-analysis included a search of the EMBASE, PubMed, Web of Science, and Cochrane Library databases from their inception to May 18, 2023, for studies analyzing cardiac morphology and functional changes in patients with SCH before and after thyroid hormone replacement. The outcome measures were cardiac morphology and diastolic and overall cardiac function, as assessed using ultrasound parameters (including ventricular wall thickness, chamber size, mitral wave flow, tissue Doppler, and speckle tracking). The quality of the studies was assessed using the Newcastle-Ottawa Scale. The standard mean differences (MDs) and 95% confidence intervals (CI) were calculated using fixed- or random-effects models.
RESULTS
Seventeen studies met the inclusion criteria. A total of 568 patients participated and completed the follow-up. All studies specifically stated that serum thyrotropin levels returned to normal by the end of the study period. Compared with baseline levels, no significant morphological changes were observed in the heart. In terms of diastolic function, we discovered that the ratios of E-velocity to A-velocity (E/A) had greatly improved after thyroid hormone replacement therapy, whereas the ratios of the mitral inflow E wave to the tissue Doppler e' wave (E/e') had not. Global longitudinal strain (GLS) increased significantly after treatment with levothyroxine.
CONCLUSION
In adult patients with SCH, thyroid hormone supplementation can partially but not completely improve parameters of diastolic function during the observation period. This meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 statement, an updated guideline for reporting systematic reviews (11) and was registered with INPLASY (INPLASY202320083).
SYSTEMATIC REVIEW REGISTRATION
https://inplasy.com/inplasy-2023-2-0083.
Topics: Adult; Humans; Echocardiography; Hormone Replacement Therapy; Hypothyroidism; Thyroxine; Ventricular Function, Left; Diastole
PubMed: 37818087
DOI: 10.3389/fendo.2023.1263861 -
Procedural complications associated with percutaneous mitral balloon valvotomy: A systematic review.Expert Review of Cardiovascular Therapy Dec 2022As Percutaneous mitral balloon valvotomy (PMBV) remains the keystone in treating mitral stenosis, we conducted this review to elucidate the cumulative frequency and...
BACKGROUND
As Percutaneous mitral balloon valvotomy (PMBV) remains the keystone in treating mitral stenosis, we conducted this review to elucidate the cumulative frequency and predictors of complications following PMBV and their occurrence in various patient populations.
AREAS COVERED
We searched digital databases for relevant studies covering complications of PMBV and retrieved articles using the Medical Subject Heading (MeSH) keywords.
EXPERT OPINION
A total of 37 articles (8 RCTs, 7 nonrandomized clinical trials, 22 observational studies) were selected for qualitative analysis. A total of 11,803 patients undergoing PMBV among 37 studies were included, with a mean success rate of 84.54%. The most common complication was mitral regurgitation (8.2%) followed by an atrial septal defect (2.4%). Other relevant complications like stroke, pericardial tamponade, rupture of mitral leaflets, and conduction abnormalities were present in <1% of the patients.
Topics: Humans; Balloon Valvuloplasty; Mitral Valve Stenosis; Mitral Valve Insufficiency; Cardiac Surgical Procedures
PubMed: 36421070
DOI: 10.1080/14779072.2022.2152328 -
Neurological Sciences : Official... May 2024Myophosphorylase deficiency, also known as McArdle disease or Glycogen Storage Disease type V (GSD-V), is an autosomal recessive metabolic myopathy that results in... (Review)
Review
INTRODUCTION AND METHODS
Myophosphorylase deficiency, also known as McArdle disease or Glycogen Storage Disease type V (GSD-V), is an autosomal recessive metabolic myopathy that results in impaired glycogen breakdown in skeletal muscle. Despite being labelled as a "pure myopathy," cardiac involvement has been reported in some cases, including various cardiac abnormalities such as electrocardiographic changes, coronary artery disease, and cardiomyopathy. Here, we present a unique case of a 72-year-old man with GSD-V and both mitral valvulopathy and coronary artery disease, prompting a systematic review to explore the existing literature on cardiac comorbidities in McArdle disease.
RESULTS
Our systematic literature revision identified 7 case reports and 1 retrospective cohort study. The case reports described 7 GSD-V patients, averaging 54.3 years in age, mostly male (85.7%). Coronary artery disease was noted in 57.1% of cases, hypertrophic cardiomyopathy in 28.5%, severe aortic stenosis in 14.3%, and genetic dilated cardiomyopathy in one. In the retrospective cohort study, five out of 14 subjects (36%) had coronary artery disease.
DISCUSSION AND CONCLUSION
Despite McArdle disease primarily affecting skeletal muscle, cardiac involvement has been observed, especially coronary artery disease, the frequency of which was moreover found to be higher in McArdle patients than in the background population in a previous study from a European registry. Exaggerated cardiovascular responses during exercise and impaired glycolytic metabolism have been speculated as potential contributors. A comprehensive cardiological screening might be recommended for McArdle disease patients to detect and manage cardiac comorbidities. A multidisciplinary approach is crucial to effectively manage both neurological and cardiac aspects of the disease and improve patient outcomes. Further research is required to establish clearer pathophysiological links between McArdle disease and cardiac manifestations in order to clarify the existing findings.
PubMed: 38802689
DOI: 10.1007/s10072-024-07600-x