Mitral Valve Prolapse

Valvular heart disease is a rapidly growing cause of global cardiovascular morbidity and mortality with diverse and evolving geographic distribution. The prevalence of rheumatic heart disease, the most common valvular heart disease (affecting approximately 41 million people), has been rising in developing nations, likely due to the expansion of the young adult population and the decrease in premature mortality that has resulted from improved access to antibiotics, microbiological testing, and echocardiography. Rheumatic heart disease has also been rising among the impoverished and, often, indigenous populations of developed nations, spurring public health initiatives that are aimed at alleviating healthcare disparities. Aortic valve stenotic disease is the most commonly occurring valvular pathology in developed nations (afflicting 9 million people worldwide) and its prevalence has been increasing with population aging and the increased prevalence of atherosclerosis. Aortic regurgitation is associated with diastolic, but not systolic, hypertension and it has likewise seen a rise in the developed world. Mitral regurgitation affects 24 million people worldwide, with great variability between and among nations. Primary mitral regurgitation arises as a consequence of myxomatous degeneration and mitral valve prolapse, which is largely due to genetic predispositions, while secondary mitral regurgitation accounts for 65% of cases and arises secondary to dilation and heart failure. Tricuspid regurgitation has become more prevalent in developed nations due to the increased usage of intracardiac pacemakers. Infective endocarditis prevalence has also grown in developed nations, likely due to population aging and the increased utilization of transcatheter valve replacement and prosthetic valves as interventions against the previously discussed valvular pathologies.

Mitral valve (MV) dynamics depends on a force balance across the mitral leaflets, the chordae tendineae, the mitral annulus, the papillary muscles and the adjacent ventricular wall. Chordae rupture disrupts the link between the MV and the left ventricle (LV), causing mitral regurgitation (MR), the most common valvular disease. In this study, a fluid-structure interaction (FSI) modeling framework is implemented to investigate the impact of chordae rupture on the left heart (LH) dynamics and severity of MR. A control and seven chordae rupture LH models were developed to simulate a pathological process in which minimal chordae rupture precedes more extensive chordae rupture. Different non-eccentric and eccentric regurgitant jets were identified during systole. Cardiac efficiency was evaluated by the ratio of external stroke work. MV structural results showed that basal/strut chordae were the major load-bearing chordae. An increased number of ruptured chordae resulted in reduced basal/strut tension, but increased marginal/intermediate load. Chordae rupture in a specific scallop did not necessarily involve an increase in the stress of the entire prolapsed leaflet. This work represents a further step towards patient-specific modeling of pathological LH dynamics, and has the potential to improve our understanding of the biomechanical mechanisms and treatment of primary MR.

Cardiovascular diseases (CVDs) are a prominent cause of death globally. The introduction of medical big data and Artificial Intelligence (AI) technology encouraged the effort to develop and deploy deep learning models for distinguishing heart sound abnormalities. These systems employ phonocardiogram (PCG) signals because of their lack of sophistication and cost-effectiveness. Automated and early diagnosis of cardiovascular diseases (CVDs) helps alleviate deadly complications. In this research, a cardiac diagnostic system that combined CNN and LSTM components was developed, it uses phonocardiogram (PCG) signals, and utilizes either augmented or non-augmented datasets. The proposed model discriminates five heart valvular conditions, namely normal, Aortic Stenosis (AS), Mitral Regurgitation (MR), Mitral Stenosis (MS), and Mitral Valve Prolapse (MVP). The findings demonstrate that the suggested end-to-end architecture yields outstanding performance concerning all important evaluation metrics. For the five classes problem using the open heart sound dataset, accuracy was 98.5%, F1-score was 98.501%, and Area Under the Curve (AUC) was 0.9978 for the non-augmented dataset and accuracy was 99.87%, F1-score was 99.87%, and AUC was 0.9985 for the augmented dataset. Model performance was further evaluated using the PhysioNet/Computing in Cardiology 2016 challenge dataset, for the two classes problem, accuracy was 93.76%, F1-score was 85.59%, and AUC was 0.9505. The achieved results show that the proposed system outperforms all previous works that use the same audio signal databases. In the future, the findings will help build a multimodal structure that uses both PCG and ECG signals.

BackgroundArrhythmic mitral valve prolapse (AMVP), a condition with known female predominance, has been linked to mitral annular disjunction (MAD), yet the relationship between MAD, sex, body size, and arrhythmic events remains unclear.ObjectivesTo determine whether MAD exhibits sex-based differential effects on arrhythmic risk and explore the implications of indexing MAD measurements.MethodsWe examined 682 consecutive MVPs at the University of California San Francisco (2013-23) with detailed clinical, rhythmic, and echocardiographic data. Mitral annular disjunction was indexed to body surface area, resulting in the identification of 3 distinct groups: no MAD and indexed MAD (iMAD) below and iMAD above the median. Arrhythmic mitral valve prolapse was defined as MVP with frequent and/or complex ventricular ectopy, including severe arrhythmic events such as sustained ventricular tachycardia, ventricular fibrillation/sudden cardiac arrest, or death.ResultsAmong 682 MVP patients (48% women, mean age 58 ± 17 years), 35% had AMVP and 41% had MAD, with a median iMAD of 4 mm. Compared to women, men had greater absolute MAD length (9.0 ± 3.2 mm vs 7.3 ± 2.6, P 4 mm was significantly associated with arrhythmic events in men but not in women (P = .02 vs P = .63). Bileaflet MVP had a direct effect on severe arrhythmic events in women (P = .04 for MVP, P = .39 in mediation analysis), but in men this association was mediated by iMAD length (P = .03).ConclusionIn a large MVP cohort, men exhibit greater MAD length and a stronger association between iMAD length and arrhythmic events. In contrast, iMAD length in women may be less important for arrhythmic risk stratification compared to other imaging parameters such as bileaflet involvement. Further studies are needed to confirm alternative mechanisms beyond localized MAD-related myocardial traction in women with MVP.