☆ 4.7 Review

Mitral and Tricuspid Valve Disease in Athletes

JOURNAL OF CLINICAL MEDICINE (2023)

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Summary: Three-dimensional echocardiography (3DE) has become a routine clinical tool for evaluating mitral valve prolapse (MVP), allowing for the diagnosis of MVP, assessment of mitral valve morphology and dynamics, and quantification of mitral regurgitation. This review focuses on the role and advantages of 3DE in the comprehensive evaluation of MVP, as well as intraoperative and intraprocedural monitoring.

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Review Sport Sciences

Athlete's heart or heart disease in the athlete? Evaluation by cardiopulmonary exercise testing

Andrea Segreti et al.

Summary: Routine or vigorous training in athletes leads to cardiovascular adaptations that enhance oxygen delivery to muscles. Cardiopulmonary exercise testing is an accurate method to evaluate performance, integrating traditional exercise parameters with breath-by-breath analysis. This review highlights the applications of this test in identifying cardiovascular adaptations and distinguishing athlete's heart from early cardiomyopathy, providing essential information about athletes' physiology.

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Review Cardiac & Cardiovascular Systems

Tricuspid regurgitation: recent advances in understanding pathophysiology, severity grading and outcome

Rebecca T. Hahn et al.

Summary: Heightened interest in tricuspid regurgitation (TR) is due to the association of mortality with severity of TR and low surgical treatment use. With the development of transcatheter solutions, there is a growing need to understand and diagnose the disease for appropriate management.

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Review Medicine, General & Internal

Diagnosis of Mitral Valve Prolapse: Much More than Simple Prolapse. Multimodality Approach to Risk Stratification and Therapeutic Management

Ali Alenazy et al.

Summary: Mitral valve prolapse (MVP) is a common valvular disease that can potentially lead to complex arrhythmias and cardiac arrest. This condition mainly affects young women and is associated with bileaflet prolapse and mitral regurgitation. The relationship between MVP and cardiac arrest is still not fully understood, and further research is needed to determine prognostic factors. Transthoracic echocardiography is the primary diagnostic tool for MVP, while cardiac magnetic resonance can be used to detect myocardial fibrosis.

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The non-invasive assessment of myocardial work by pressure-strain analysis: clinical applications

Dawud Abawi et al.

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Novel insights into the athlete's heart: is myocardial work the new champion of systolic function?

Marton Tokodi et al.

Summary: This study investigated the correlation between MW and invasively measured contractility, as well as the association between MW and aerobic capacity. The findings suggest that GMWI precisely reflects LV contractility and captures supernormal systolic performance in athletes even at rest.

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Patrizio Lancellotti et al.

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Davide Domenico Borzi et al.

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How to manage an athlete with mitral valve prolapse

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Summary: This article provides clinical and useful data to manage athletes with mitral valve prolapse and to distinguish high-risk athletes carrying the features of arrhythmic mitral valve prolapse.

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Right atrial volume is a major determinant of tricuspid annulus area in functional tricuspid regurgitation: a three-dimensional echocardiographic study

Denisa Muraru et al.

Summary: This study aimed to explore the relationship between tricuspid annulus area (TAA) and right atrial maximal volume (RAVmax) and right ventricular end-diastolic volume (RVEDV) in healthy subjects and patients with functional tricuspid regurgitation (FTR) of different etiologies and severities. The study found that RAVmax is the main determinant of TAA, and right atrial enlargement is an important mechanism of TAA dilation in FTR patients, regardless of the underlying conditions causing the FTR.

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Geometrical remodeling of the mitral and tricuspid annuli in response to exercise training: a 3-D echocardiographic study in elite athletes

Alexandra Fabian et al.

Summary: The study showed that athletes have larger MA and TA areas, as well as tenting volumes compared to controls. Athletes with MR had significantly higher MA and TA areas. Athletic adaptation is characterized by both annular enlargement and increased leaflet tenting of both valves. Differences in MA geometry were observed between athletes with and without FMR.

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Exercise-Induced Cardiovascular Adaptations and Approach to Exercise and Cardiovascular Disease JACC State-of-the-Art Review

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Prevalence and extent of mitral annular disjunction in structurally normal hearts: comprehensive 3D analysis using cardiac computed tomography

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Summary: Mitral annular disjunction is a common finding in the normal adult heart, with a bimodal distribution predominantly involving the P1 and P3 scallops of the posterior mitral leaflet.

EUROPEAN HEART JOURNAL-CARDIOVASCULAR IMAGING (2021)

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Myocardial Work by Echocardiography: Principles and Applications in Clinical Practice

Federica Ilardi et al.

Summary: Left ventricular global longitudinal strain (GLS) and non-invasive myocardial work (MW) quantification are two new methods for assessing myocardial function, able to overcome limitations of previous methods and provide a more reliable evaluation of myocardial performance without load dependency.

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Antonello D'Andrea et al.

Summary: The article aims to assist clinicians in identifying the difference between athlete's heart and structural cardiac disease through a series of imaging tests to reduce the risk of sudden cardiac death.

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Reza Mazaheri et al.

Summary: CPET allows accurate measurement of cardiorespiratory fitness and performance in athletes, providing key functional physiologic indices for assessment. Highly trained athletes often have improved CPET values, potentially masking underlying medical disorders. This testing can also be utilized to assess athletic performance using physiological parameters.

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Athletes with valvular heart disease and competitive sports: a position statement of the Sport Cardiology Section of the European Association of Preventive Cardiology

Frank van Buuren et al.

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Bradley J. Petek et al.

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CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE (2021)

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Prognostic Implications of Left Ventricular Myocardial Work Indices in Patients With Secondary Mitral Regurgitation

Idit Yedidya et al.

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2021 ESC Guidelines on cardiovascular disease prevention in clinical practice Developed by the Task Force for cardiovascular disease prevention in clinical practice with representatives of the European Society of Cardiology and 12 medical societies With the special contribution of the European Association of Preventive Cardiology (EAPC)

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Tom Kai Ming Wang et al.

Summary: A strong understanding of the anatomy and pathologies of the tricuspid valve is crucial for evaluating and managing tricuspid regurgitation (TR). Various imaging modalities play important roles in assessing TR and guiding surgical and percutaneous interventions, in combination with clinical factors to determine treatment strategies.

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Summary: The study revealed that even in the absence of significant mitral regurgitation, patients with mitral valve prolapse exhibit abnormalities in the left ventricle, including LV enlargement and basal inferolateral hypertrophy. These abnormalities persist even without significant MR, suggesting that MVP not only affects the mitral valve but also involves the adjacent myocardium.

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Anna Giulia Pavon et al.

Summary: This study evaluated the relationship between MAD severity and myocardial interstitial fibrosis in MVP patients, as well as the association between interstitial fibrosis severity and ventricular arrhythmic events. Results showed that ECVsyn, a marker of interstitial fibrosis, was elevated in MVP-MAD patients even without LGE, and was correlated with MAD length and increased risk of out-of-hospital cardiac arrest. ECV assessment may provide additional value in arrhythmic risk stratification beyond LGE evaluation in MVP patients.

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Michael Johannes Schindler et al.

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Rebecca T. Hahn

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Lynne Martina Millar et al.

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Antonello D'Andrea et al.

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The clinical use of stress echocardiography in non-ischaemic heart disease: recommendations from the European Association of Cardiovascular Imaging and the American Society of Echocardiography

Patrizio Lancellotti et al.

EUROPEAN HEART JOURNAL-CARDIOVASCULAR IMAGING (2016)

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Article Cardiac & Cardiovascular Systems

Arrhythmic Mitral Valve Prolapse and Sudden Cardiac Death

Cristina Basso et al.

CIRCULATION (2015)

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Article Sport Sciences

Atrial Size and Function in Athletes

G. F. Gjerdalen et al.

INTERNATIONAL JOURNAL OF SPORTS MEDICINE (2015)

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Article Cardiac & Cardiovascular Systems

Recommendations for Cardiac Chamber Quantification by Echocardiography in Adults: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging

Roberto M. Lang et al.

JOURNAL OF THE AMERICAN SOCIETY OF ECHOCARDIOGRAPHY (2015)

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Article Cardiac & Cardiovascular Systems

Endurance Exercise-Induced Cardiac Remodeling: Not All Sports Are Created Equal

Meagan M. Wasfy et al.

JOURNAL OF THE AMERICAN SOCIETY OF ECHOCARDIOGRAPHY (2015)

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Article Cardiac & Cardiovascular Systems

Pathogenic structural heart changes in early tricuspid regurgitation

Naohiko Nemoto et al.

JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY (2015)

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Review Cardiac & Cardiovascular Systems

Therapeutic decision-making for patients with fluctuating mitral regurgitation

Patrizio Lancellotti et al.

NATURE REVIEWS CARDIOLOGY (2015)

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Article Cardiac & Cardiovascular Systems

Left Atrium Size in Elite Athletes

Aline Iskandar et al.

JACC-CARDIOVASCULAR IMAGING (2015)

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Article Cardiac & Cardiovascular Systems

Chronic adaptation of atrial structure and function in elite male athletes

Gavin McClean et al.

EUROPEAN HEART JOURNAL-CARDIOVASCULAR IMAGING (2015)

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Article Cardiac & Cardiovascular Systems

Eligibility and Disqualification Recommendations for Competitive Athletes With Cardiovascular Abnormalities: Task Force 5: Valvular Heart Disease A Scientific Statement From the American Heart Association and American College of Cardiology

Robert O. Bonow et al.

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY (2015)

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Article Cardiac & Cardiovascular Systems

Cardiac Remodeling in Response to 1 Year of Intensive Endurance Training

Armin Arbab-Zadeh et al.

CIRCULATION (2014)

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Article Cardiac & Cardiovascular Systems

Epidemiology and Pathophysiology of Mitral Valve Prolapse New Insights Into Disease Progression, Genetics, and Molecular Basis

Francesca N. Delling et al.

CIRCULATION (2014)

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Article Cardiac & Cardiovascular Systems

2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines

Rick A. Nishimura et al.

CIRCULATION (2014)

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Article Cardiac & Cardiovascular Systems

Morphological and Functional Adaptation of Left and Right Atria Induced by Training in Highly Trained Female Athletes

Flavio D'Ascenzi et al.

CIRCULATION-CARDIOVASCULAR IMAGING (2014)

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Editorial Material Cardiac & Cardiovascular Systems

Does Left Atrial Enlargement Contribute to Mitral Leaflet Tethering in Patients with Functional Mitral Regurgitation? Proposed Role of Atriogenic Leaflet Tethering

Jeffrey J. Silbiger

ECHOCARDIOGRAPHY-A JOURNAL OF CARDIOVASCULAR ULTRASOUND AND ALLIED TECHNIQUES (2014)

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Article Cardiac & Cardiovascular Systems

Left ventricular contractile reserve in asymptomatic primary mitral regurgitation

Julien Magne et al.

EUROPEAN HEART JOURNAL (2014)

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Article Cardiac & Cardiovascular Systems

Echocardiographic Predictors of Mitral Regurgitation in High School and Collegiate Competitive Athletes

Robert F. Hamburger et al.

AMERICAN JOURNAL OF CARDIOLOGY (2013)

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Article Cardiac & Cardiovascular Systems

Importance of Three-Dimensional Geometric Analysis in the Assessment of the Athlete's Heart

Chun G. Schiros et al.

AMERICAN JOURNAL OF CARDIOLOGY (2013)

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Article Cardiac & Cardiovascular Systems

Quantitative Analysis of Mitral Valve Morphology in Mitral Valve Prolapse With Real-Time 3-Dimensional Echocardiography Importance of Annular Saddle Shape in the Pathogenesis of Mitral Regurgitation

Alex Pui-Wai Lee et al.

CIRCULATION (2013)

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Article Cardiac & Cardiovascular Systems

Quantification of Chronic Functional Mitral Regurgitation by Automated 3-Dimensional Peak and Integrated Proximal Isovelocity Surface Area and Stroke Volume Techniques Using Real-Time 3-Dimensional Volume Color Doppler Echocardiography In Vitro and Clinical Validation

Paaladinesh Thavendiranathan et al.

CIRCULATION-CARDIOVASCULAR IMAGING (2013)

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Article Cardiac & Cardiovascular Systems

Range of right heart measurements in top-level athletes: The training impact

Antonello D'Andrea et al.

INTERNATIONAL JOURNAL OF CARDIOLOGY (2013)

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Article Cardiac & Cardiovascular Systems

Italian Cardiological Guidelines for Sports Eligibility in Athletes with Heart Disease: Part 1

Alessandro Biffi et al.

JOURNAL OF CARDIOVASCULAR MEDICINE (2013)

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Review Cardiac & Cardiovascular Systems

Novel Pathogenetic Mechanisms and Structural Adaptations in Ischemic Mitral Regurgitation

Jeffrey J. Silbiger

JOURNAL OF THE AMERICAN SOCIETY OF ECHOCARDIOGRAPHY (2013)

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Article Cardiac & Cardiovascular Systems

Normal Ranges of Left Ventricular Strain: A Meta-Analysis

Teerapat Yingchoncharoen et al.

JOURNAL OF THE AMERICAN SOCIETY OF ECHOCARDIOGRAPHY (2013)

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Article Cardiac & Cardiovascular Systems

Exercise-induced right ventricular dysfunction and structural remodelling in endurance athletes

Andre La Gerche et al.

EUROPEAN HEART JOURNAL (2012)

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Article Cardiac & Cardiovascular Systems

A novel clinical method for quantification of regional left ventricular pressurestrain loop area: a non-invasive index of myocardial work

Kristoffer Russell et al.

EUROPEAN HEART JOURNAL (2012)

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Article Cardiac & Cardiovascular Systems

Relationship between mitral leaflets angles, left ventricular geometry and mitral deformation indices in patients with ischemic mitral regurgitation: imaging by echocardiography and cardiac magnetic resonance

Agata Lesniak-Sobelga et al.

INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING (2012)

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Review Cardiac & Cardiovascular Systems

Heart valve disease: investigation by cardiovascular magnetic resonance

Saul G. Myerson

JOURNAL OF CARDIOVASCULAR MAGNETIC RESONANCE (2012)

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Article Cardiac & Cardiovascular Systems

In Vitro Characterization of the Mechanisms Responsible for Functional Tricuspid Regurgitation

Erin M. Spinner et al.

CIRCULATION (2011)

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Article Cardiac & Cardiovascular Systems

Mitral Valve Abnormalities Identified by Cardiovascular Magnetic Resonance Represent a Primary Phenotypic Expression of Hypertrophic Cardiomyopathy

Martin S. Maron et al.

CIRCULATION (2011)

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Article Cardiac & Cardiovascular Systems

Exercise Hemodynamics in Valvular Heart Disease

Anna M. Booher et al.

Current Cardiology Reports (2011)

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Article Cardiac & Cardiovascular Systems

Evaluation of Tricuspid Valve Morphology and Function by Transthoracic Three-Dimensional Echocardiography

Denisa Muraru et al.

Current Cardiology Reports (2011)

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Article Cardiac & Cardiovascular Systems

Mitral annular disjunction in myxomatous mitral valve disease: a relevant abnormality recognizable by transthoracic echocardiography

Pedro Carmo et al.

CARDIOVASCULAR ULTRASOUND (2010)

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Article Cardiac & Cardiovascular Systems

Exercise-Induced Changes in Degenerative Mitral Regurgitation

Julien Magne et al.

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY (2010)

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Article Cardiac & Cardiovascular Systems

Cardiovascular Magnetic Resonance Imaging for Valvular Heart Disease Technique and Validation

Peter J. Cawley et al.

CIRCULATION (2009)

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Review Cardiac & Cardiovascular Systems

Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice

Helmut Baumgartner et al.

EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY (2009)

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Review Medicine, General & Internal

Mitral stenosis

Y. Chandrashekhar et al.

LANCET (2009)

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Article Cardiac & Cardiovascular Systems

Left Ventricular Response to Mitral Regurgitation Implications for Management

William H. Gaasch et al.

CIRCULATION (2008)

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Article Cardiac & Cardiovascular Systems

Prevalence and clinical significance of left atrial remodeling in competitive athletes

A Pelliccia et al.

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY (2005)

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Review Cardiac & Cardiovascular Systems

Ischemic mitral regurgitation on the threshold of a solution - From paradoxes to unifying concepts

RA Levine et al.

CIRCULATION (2005)

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Article Cardiac & Cardiovascular Systems

Exercise-induced changes in mitral regurgitation in patients with prior myocardial infarction and left ventricular dysfunction: relation to mitral deformation and left ventricular function and shape

V Giga et al.

EUROPEAN HEART JOURNAL (2005)

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Article Cardiac & Cardiovascular Systems

Real-time three-dimensional echocardiography for rheumatic mitral valve stenosis evaluation -: An accurate and novel approach

J Zamorano et al.

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY (2004)

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