Assessment of mitral annulus and mitral leaflet in nonvalvular atrial fibrillation patients with various degrees of mitral regurgitation: Real time 3D transesophageal echocardiography

Aim: To study the changes of mitral valve (MV) in patients with nonvalvular atrial fibrillation (NVAF)-related mitral regurgitation (MR) and the relationship between MV parameters and the enlarged left atrium (LA). Materials and Methods: A total of 43 patients with NVAF were divided into two groups: (1) the MR1 group with mild MR and (2) the MR2 group with moderate-to-severe MR. Real time 3D transesophageal echocardiography (TEE) was performed to detect the structure of MV. Results: There were no significant differences in the basic characteristics among the three groups. As compared with the control group, anterolateral to posteromedial diameter of the annulus (DALPm), anterior to posterior diameter (DAP), three-dimensional circumference (C3D), two-dimensional area (A2D), three-dimensional area (A3D), exposed area of the leaflets (A3DE), and NPA (nonplanar angle) were significantly increased, whereas height and ellipticity were significantly decreased in the MR1 group and MR2 group. The overall longitudinal strain of left atrium (GLS) was significantly decreased in the MR1 and MR2 groups compared to the control group. Furthermore, GLS was inversely correlated with DALPm, DAP, C3D, A2D, A3D, A3DE, and NPA, whereas positively correlated with height, ellipticity, and the leaflet tenting height in both MR1 and MR2 groups. Conclusion: Even in NVAF patients with mild MR, the structure of MV was changed intensively with the expansion and deformation of the saddle shape structure. The deformation of MV was associated with the decreased function of LA. Our results may provide novel insight into evaluation risk factors leading to AF recurrence after ablation procedures.