Background: Cardiac multidetector computed tomography (MDCT) has been mainly applied in the diagnosis of valvular heart morphology and function along with the assessment of coronary artery disease. This study aimed to evaluate the diagnostic performance of coronary MDCT angiography for the diagnosis of mitral valve prolapse (MVP), as compared to transthoracic echocardiography (TTE).
Materials and Methods: A total of 40 patients who had undergone both TTE and MDCT within a three-month period were included in the study. Two parameters of mitral valve leaflet thickness and leaflet billowing were measured using both techniques. The MDCT results were compared with those of TTE, which was the reference standard.
Results: Implementing the Receiver Operating Characteristic (ROC) test on the data for MDCT-measured leaflet billowing received from MDCT angiography suggests that the area under the ROC curve is 96% for a declared variable, which is absolutely significant (P < 0.001), and MDCT-measured leaflet billowing is an appropriate index for the diagnosis of mitral valve prolapse. On the basis of the achieved cut-off point from the ROC analysis (which equals 2.5 mm leaftlet billowing) the MDCT-measured leaflet billowing takes a sensitivity and specificity of 68.4 and 95.2%. The false positive and false negative results are 4.8 and 31.6%. The positive and negative predictive values (PPV and NPV) of the revealed test indicate 92.9 and 76.9%, respectively. Finally, the consistency of the MDCT measured leaflet billowing for diagnosing the mitral valve prolapse is 82.5%. Based on the mentioned test, the consistency of the MDCT-measured leaflet thickness test is 47.5%.
Conclusion: Along with the assessment of coronary arteries, the presence or absence of MVP can be reliably evaluated by MDCT angiography.
American College of Cardiology/American Heart Association. ACC/AHA 2006 guidelines for the management of patients with valvular heart disease. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing committee to revise the 1998 guidelines for the Manag. J Am Coll Cardiol 2006;48:1-148.
Perloff JK, Child JS, Edwards JE. New guidelines for the clinical diagnosis of mitral valve prolapse. Am J Cardiol 1986;57:1124-9.
Izumo M, Shiota M, Kar S, Gurudevan SV, Tolstrup K, Siegel RJ, et al. Comparison of real-time three-dimensional transesophageal echocardiography to two-dimensional transesophageal echocardiography for quantification of mitral valve prolapse in patients with severe mitral regurgitation. Am J Cardiol 2013;111:588-94.
Ciancamerla F, Paglia I, Catuzzo B, Morello M, Mangiardi L. Sudden death in mitral valve prolapse and severe mitral regurgitation. Is chordal rupture an indication to early surgery? J Cardiovasc Surg (Torino) 2003;44:283-6.
Levine RA, Stathogiannis E, Newell JB, Harrigan P, Weyman AE. 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;11:1010-9.
Messika-Zeitoun D, Serfaty JM, Laissy JP, Berhili M, Brochet E, Iung B, et al. Assessment of the mitral valve area in patients with mitral stenosis by multislice computed tomography. J Am Coll Cardiol 2006;48:411-3.
Hendel RC, Patel MR, Cramer CM, Poon M, Hendel RC, Carr JC, et al. American College of Cardiology Foundation Quality Strategic Directions Committee Appropriateness Criteria WorkingGroup; American College of Radiology; Society of Cardiovascular Computed Tomography; Society for Cardiovascular Magnetic Resonance; American Society of Nuclear Cardiology; North American Society for Cardiac Imaging; Society for Cardiovascular Angiography and Interventions; Society of Interventional Radiology. ACCF/ACR/SCCT/SCMR/ASNC/NASCI/SCAI/SIR 2006 appropriateness criteria for cardiac computed tomography and cardiac magnetic resonance imaging: A report of the American College of Cardiology Foundation Quality Strategic Directions Committee Appropriateness Criteria Working Group, American College of Radiology, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, American Society of Nuclear Cardiology, North American Society for Cardiac Imaging, Society for Cardiovascular Angiography and Interventions, and Society of Interventional Radiology. J Am Coll Cardiol 2006;48:1475-97.