Hostname: page-component-848d4c4894-x24gv Total loading time: 0 Render date: 2024-06-07T13:47:35.730Z Has data issue: false hasContentIssue false
  • English
  • Français

Aortic elasticity and carotid intima-media thickness in children with mitral valve prolapse

Published online by Cambridge University Press:  07 November 2017

Elif Erolu ,
Figen Akalın ,
Nilüfer Çetiner  and
Berna Şaylan Çevik
Elif Erolu*
Affiliation:
Department of Pediatrics, Divisions of Pediatric Cardiology, Marmara University Faculty of Medicine, İstanbul, Turkey
Figen Akalın
Affiliation:
Department of Pediatrics, Divisions of Pediatric Cardiology, Marmara University Faculty of Medicine, İstanbul, Turkey
Nilüfer Çetiner
Affiliation:
Department of Pediatrics, Divisions of Pediatric Cardiology, Marmara University Faculty of Medicine, İstanbul, Turkey
Berna Şaylan Çevik
Affiliation:
Department of Pediatrics, Divisions of Pediatric Cardiology, Marmara University Faculty of Medicine, İstanbul, Turkey
*
Correspondence to: E. Erolu, Department of Pediatrics, Divisions of Pediatric Cardiology, Marmara University Faculty of Medicine, Fevzi Çakmak Mah. Muhsin Yazıcıoğlu Cad. No: 10 Üst Kaynarca, Pendik, Istanbul 34662, Turkey. Tel: +90 505 816 94 56; Fax: +90 216 632 71 21; E-mail: eliferolu@yahoo.com
Get access Rights & Permissions [Opens in a new window]

Abstract

Aim

We aimed to study the dimensions, systolic and diastolic functions of the left ventricle; dimensions and elasticity of the aorta; and carotid intima-media thickness and flow-mediated dilatation of the brachial artery in mitral valve prolapse.

Methods

The study group consisted of 43 patients (mean age=13.3±3.9) and 42 healthy children (mean age=12.9±3.4). Left ventricular end-diastolic, end-systolic, left atrial diameters, interventricular septum, and left ventricular posterior wall thickness were measured. Ejection and shortening fractions were calculated by M-mode. Measurements were adjusted to the body surface area. Mitral annulus, and systolic and diastolic diameters of the aortic annulus and aorta at each level were obtained; z-scores, aortic strain, distensibility, stiffness index were calculated. Carotid intima-media thickness and flow-mediated dilatation were studied. Patients were classified as classical/non-classical mitral valve prolapse and younger/older patients.

Results

Left ventricular end-systolic, end-diastolic, and left atrial diameters (p=0.009, p=0.024, p=0.001) and aortic z-scores at annulus, sinus valsalva, and sinotubuler junction were larger (p=0.008, p=0.003, p=0.002, respectively) in the mitral valve prolapse group. Aortic strain and distensibility increased and stiffness decreased at the ascending aorta in the patient group (p=0.012, 0.020, p=0.019, respectively). Classical mitral valve prolapse had lower strain and distensibility and higher stiffness of the aorta at sinus valsalva level (p=0.010, 0.027, 0.004, respectively). Carotid intima-media thickness was thinner in the patient group, especially in the non-classical mitral valve prolapse group (p=0.037). Flow-mediated dilatation did not differ among the groups.

Conclusion

Mitral valve prolapse is a systemic disease of the connective tissue causing enlarged cardiac chambers and increased elasticity of the aorta. Decreased carotid intima-media thickness in this group may indicate low atherosclerosis risk.

Keywords

Mitral valve prolapsechildrenaortic elasticitycarotid intima-media thickness
Type
Original Articles
Information
Cardiology in the Young , Volume 28 , Issue 2 , February 2018 , pp. 292 - 301
Check for updates
Copyright
© Cambridge University Press 2017 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Bonow, RO, Carabello, B, Leon, AC Jr, et al. ACC/AHA guidelines for the management of patients with valvular heart disease: a report of American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients With Valvular Heart Disease). J Am Coll Cardiol 1998; 32: 1486–1588.CrossRefGoogle Scholar
2. Glesby, MJ, Pyeritz, RE. Association of mitral valve prolapse and systemic abnormalities of connective tissue. A phenotypic continuum. JAMA 1989; 262: 523–528.CrossRefGoogle ScholarPubMed
3. Nesta, F, Leyne, M, Yosefy, C, et al. New locus for mitral valve prolapse on chromosome 13: clinical insights from genetic studies. Circulation 2005; 112: 2022–2030.CrossRefGoogle ScholarPubMed
4. Rabkin, E, Aikawa, M, Stone, JR, Fukumoto, Y, Libby, P, Schoen, FJ. Activated interstitial myofibroblasts express catabolic enzymes and mediate matrix remodeling in myxomatous heart valves. Circulation 2001; 104: 2525–2532.CrossRefGoogle ScholarPubMed
5. Grande-Allen, KJ, Griffin, BP, Calabro, A, Ratliff, NB, Cosgrove, DM, Vesely, I. Myxomatous mitral valve chordae. II: selective elevation of glycosaminoglycan content. J Heart Valve Dis 2001; 10: 325–333.Google ScholarPubMed
6. Chou, HT, Shi, YR, Hsu, Y, Tsai, FJ. Association between fibrillin-1 gene, exon 15 and 27 polymorphisms and risk of mitral valve prolapse. J Heart Valve Dis 2003; 12: 475–481.Google ScholarPubMed
7. Chou, HT, Chen, YT, Wu, JY, Tsai, FJ. Association between urokinase-plasminogen activator gene T4065C polymorphism and risk of mitral valve prolapse. Int J Cardiol 2004; 96: 165–170.CrossRefGoogle ScholarPubMed
8. Chou, HT, Hung, JS, Chen, YT, Wu, JY, Tsai, FJ. Association between COL3A1 collagen gene exon 31 polymorphism and risk of floppy mitral valve/mitral valve prolapse. Int J Cardiol 2004; 95: 299–305.CrossRefGoogle ScholarPubMed
9. Pitcher, D, Grahame, R. Mitral valve prolapse and joint hypermobility: evidence for a systemic connective tissue abnormality? Ann Rheum Dis 1982; 41: 352–354.CrossRefGoogle ScholarPubMed
10. Nascimento, R, Freitas, A, Teixeria, F, et al. Is mitral valve prolapse a congenital or acquired disease? Am J Cardiol 1997; 79: 226–227.CrossRefGoogle ScholarPubMed
11. Hickey, AJ, Wilcken, DE. Age and the clinical profile of idiopathic mitral valve prolapse. Br Heart J 1986; 55: 582–586.CrossRefGoogle ScholarPubMed
12. Moesgaard, SG, Olsen, LH, Viuff, BM, et al. Increased nitric oxide release and expression of endothelial and inducible nitric oxide release and expression of endothelial and inducible nitric oxide synthases in mildly changed porcine mitral valve leaflets. J Heart Valve Dis 2007; 16: 67–75.Google ScholarPubMed
13. Mow, T, Pedersen, HD. Increased endothelin-receptor density in myxomatous canine mitral valve leaflets. J Cardiovasc Pharmacol 1999; 34: 254–260.CrossRefGoogle ScholarPubMed
14. Unlu, M, Demirkol, S, Aparci, M, et al. Why aortic elasticity differs among classical and non-classical mitral valve prolapsed? Clin Exp Hypertens 2014; 36: 148–152.CrossRefGoogle ScholarPubMed
15. Fritze, O, Romero, B, Scleicher, M, et al. Age-related changes in the elastic tissue of the human aorta. J Vasc Res 2012; 49: 77–86.CrossRefGoogle ScholarPubMed
16. Lopez, L, Colan, SD, Frommelt, PC, et al. Recommendations for quantification methods during the performance of a pediatric echocardiogram: a report from the pediatric measurements writing group of the American Society of Echocardiography Pediatric and Congenital Heart Disease Council. J Am Soc Echocardiogr 2010; 23: 465–495.CrossRefGoogle ScholarPubMed
17. Heyek, E, Gring, GN, Griffin, BP. Mitral valve prolapsed. Lancet 2005; 365: 507–518.CrossRefGoogle Scholar
18. Perloff, JK, Child, JS. Mitral valve prolapse: evolution and refinement of diagnostic techniques. Circulation 1989; 80: 710–711.CrossRefGoogle ScholarPubMed
19. Levine, RA, Stathogiannis, E, Newell, JB, et al. Reconsideration of echocardiographic standards for mitral valve prolapse: lack of association between leaflet displacement isolated to the apical four chamber view and independent echocardiographic evidence of abnormality. J Am Coll Cardiol 1988; 11: 1010–1019.CrossRefGoogle Scholar
20. Lancellotti, P, Moura, L, Pierard, LA, et al. European Association of Echocardiography recommendations for the assessment of valvular regurgitation. Part 2: mitral and tricuspid regurgitation (native valve disease). Eur J Echocardiogr 2010; 11: 307–332.CrossRefGoogle ScholarPubMed
21. Warren, AE, Boyd, ML, O’Connell, C, Dodds, L. Dilatation of the ascending aorta in paediatric patients with bicuspid aortic valve: frequency, rate of progression and risk factors. Heart 2006; 92: 1496–1500.CrossRefGoogle ScholarPubMed
22. Dalla Pozza, R, Ehringer-Schetitska, D, Fritsch, P, et al. Intima media thickness measurement in children: a statement from the Association for European Paediatric Cardiology (AEPC) Working Group on Cardiovascular Prevention endorsed by the Association for European Paediatric Cardiology. Atherosclerosis 2015; 238: 380–387.CrossRefGoogle Scholar
23. Celermajer, DS, Sorensen, KE, Gooch, VM, et al. Non-invasive detection of endothelial dysfunction in children and adults at risk of atherosclerosis. Lancet. 1992; 340: 1111–1115.CrossRefGoogle ScholarPubMed
24. Avierinos, J, Gersh, B, Melton, L, et al. Natural history of mitral valve prolapse in the community. Circulation. 2002; 106: 1355–1361.CrossRefGoogle ScholarPubMed
25. Boudoulas, H, Wooley, CF. (eds) Mitral Valve Prolapse and the Mitral Valve Prolapse Syndrome. Futura, Mount Kisco, NY, 1998.Google Scholar
26. Freed, LA, Benjamin, EJ, Levy, D, et al. Mitral valve prolapse in the general population: the benign natüre of echocardiographic features in the Framingham Heart Study. J Am Coll Cardiol 2002; 40: 1298–1304.CrossRefGoogle ScholarPubMed
27. Yiginer, O, Keser, N, Ozmen, N, et al. Classic mitral valve prolapse causes enlargement in left ventricle even in the absence of significant mitral regurgitation. Echocardiography. 2012; 29: 123–129.CrossRefGoogle ScholarPubMed
28. Meijboom, LJ, Timmermans, J, van Tintelen, JP, et al. Evaluation of left ventricular dimensions and function in Marfan’s syndrome without significant valvular regurgitation. Am J Cardiol 2005; 95: 329–332.CrossRefGoogle ScholarPubMed
29. Booms, P, Cisler, J, Mathews, KR, et al. Novel exon skipping mutation in the fibrillin-1 gene: two “hot spots” for the neonatal Marfan syndrome. Clin Genet. 1999; 55: 110–117.CrossRefGoogle ScholarPubMed
30. Cook, JR, Carta, L, Bénard, L, et al. Abnormal muscle mechanosignaling triggers cardiomyopathy in mice with Marfan syndrome. J Clin Invest 2014; 124: 1329–1339.Google ScholarPubMed
31. Anné, W, Willems, R, Roskams, T, et al. Matrix metalloproteinases and atrial remodeling in patients with mitral valve disease and atrial fibrillation. Cardiovasc Res 2005; 67: 655–666.CrossRefGoogle ScholarPubMed
32. Wheeler, JB, Ikonomidis, JS, Jones, JA. Connective tissue disorders and cardiovascular complications: the indomitable role of transforming growth factor-beta signaling. Adv Exp Med Biol 2014; 802: 107–127.CrossRefGoogle ScholarPubMed
33. Matos-Souza, JR, Fernandes-Santos, ME, Hoehne, EL, Franchini, KG, Nadruz, W Jr. Isolated mitral valve prolapse is an independent predictor of aortic root size in a general population. Eur J Echocardiogr 2010; 11: 302–305.CrossRefGoogle ScholarPubMed
34. Pisano, C, Maresi, E, Balistreri, CR, et al. Histological and genetic studies in patients with bicuspid aortic valve and ascending aorta complications. Interct Cardiovasc Thorac Surg 2012; 14: 300–306.CrossRefGoogle ScholarPubMed
35. Hollister, DW, Godfrey, M, Sakai, LY, et al. Immunohistologic abnormalities of the microfibrillar-fiber system in the Marfan syndrome. N Engl J Med 1990; 323: 152–159.CrossRefGoogle ScholarPubMed
36. Yazici, M, Ataoglu, S, Makarc, S, et al. The relationship between echocardiographic features of mitral valve and elastic properties of aortic wall and Beighton hypermobility score in patients with mitral valve prolapse. Jpn Heart J 2004; 45: 447–460.CrossRefGoogle Scholar
37. Kardesoglu, E, Ozmen, N, Aparci, M, Cebeci, BS, Uz, O, Dincturk, M. Abnormal elastic properties of the aorta in the mitral valve prolapse syndrome. Acta Cardiol. 2007; 62: 151–155.CrossRefGoogle ScholarPubMed
38. Akazawa, Y, Motoki, N, Tada, A, et al. Decreased aortic elasticity in children with Marfan syndrome or Loeys-Dietz syndrome. Circ J. 2016; 80: 2369–2375.CrossRefGoogle ScholarPubMed
39. Nollen, GJ, Groenink, M, Tijssen, JG, Van Der Wall, EE, Mulder, BJ. Aortic stiffness and diameter predict progressive aortic dilatation in patients with Marfan syndrome. Eur Heart J 2004; 25: 1146–1152.CrossRefGoogle ScholarPubMed
40. Cole, WG, Chan, D, Hickey, AJ, Wilcken, DE. Collagen composition of normal and myxomatous human mitral heart valves. Biochem J 1984; 19: 452–460.Google Scholar
41. Unlu, M, Demirkol, S, Aparci, M, et al. Why aortic elasticity differs among classical and non-classical mitral valve prolapsed? Clin Exp Hypertens 2014; 36: 148–152.CrossRefGoogle ScholarPubMed
42. Nemes, A, Takács, R, Gavallér, H, et al. Correlations between aortic stiffness and parasympathetic autonomic function in healthy volunteers. Can J Physiol Pharmacol 2010; 88: 1166–1171.CrossRefGoogle ScholarPubMed
43. Gaffney, FA, Karlsson, ES, Campbell, W, et al. Autonomic dysfunction in women with mitral valve prolapse syndrome. Circulation 1979; 59: 894–901.CrossRefGoogle ScholarPubMed
44. Strano, S, De Castro, S, Ferruci, A, et al. Modification of the sympathovagal interaction in mitral valve prolapse syndrome. Evaluation of heart rate variability by spectrum analysis. Cardiologia 1992; 37: 755–760.Google ScholarPubMed
45. Dietz, SM, Tacke, CE, Gort, J, et al. Carotid intima-media thickness in patients with a history of Kawasaki disease. Circ J. 2015; 79: 2682–2687.CrossRefGoogle ScholarPubMed
46. Baroncini, LAV, Sylvestre, LC, Baroncini, CV, Pecoits, RF. Assessment of carotid intima-media thickness as an early marker of vascular damage in hypertensive children. Arq Bras Cardiol 2017; 108: 452–457.Google ScholarPubMed
47. Shah, AS, Dabelea, D, Fino, NF, et al. Predictors of increased carotid intima-media thickness in youth with type 1 diabetes: the search CVD study. Diabet Care. 2016; 39: 418–425.CrossRefGoogle ScholarPubMed
48. Rumiʼnska, M, Witkowska-Sedek, E, Majcher, A, et al. Carotid intima-media thickness and metabolic syndrome components in obese children and adolescents. Adv Exp Med Biol 2017; Apr 30. doi:10.1007/5584_2017_29.CrossRefGoogle ScholarPubMed
49. Vriend, JW, de Groot, E, de Wall, TT, Zijta, FM, Kastelein, JJ, Mulder, BJ. Increased carotid and femoral intima-media thickness in patients after repair of aortic coarctation: influence of early repair. Am Heart J 2006; 151: 242–247.CrossRefGoogle ScholarPubMed
50. Gullu, H, Erdogan, D, Calıskan, M, et al. Interrelationship between noninvasive predictors of atherosclerosis: transthoracic coronary flow reverse, flow-mediated dilation, carotid intima-media thickness, aortic stiffness, aortic distensibility, elastic modulus and brachial artery diameter. Echocardiography 2006; 23: 835–842.CrossRefGoogle Scholar