Comparison of the accuracy of cardiac computed tomography angiography and transthoracic echocardiography in the diagnosis of mitral valve prolapse


Department of Radiology, Saint Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran


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.  Back to cited text no. 1
Perloff JK, Child JS, Edwards JE. New guidelines for the clinical diagnosis of mitral valve prolapse. Am J Cardiol 1986;57:1124-9.  Back to cited text no. 2
Freed LA, Levy D, Levine RA, Larson MG, Evans JC, Fuller DL, et al. Prevalence and clinical outcome of mitral-valve prolapse. N Engl J Med 1999;341:1-7.  Back to cited text no. 3
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.  Back to cited text no. 4
Avierinos JF, Gersh BJ, Melton LJ 3 rd , Bailey KR, Shub C, Nishimura RA, et al. Natural history of asymptomatic mitral valve prolapse in the community. Circulation 2002;106:1355-61.  Back to cited text no. 5
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.  Back to cited text no. 6
Devereux RB. Recent developments in the diagnosis and management of mitral valve prolapse. Curr Opin Cardiol 1995;10:107-16.  Back to cited text no. 7
Freed LA, Benjamin EJ, Levy D, Larson MG, Evans JC, Fuller DL, et al. Mitral valve prolapse in the general population: The benign nature of echocardiographic features in the Framingham Heart Study. J Am Coll Cardiol 2002;40:1298-304.  Back to cited text no. 8
Devereux RB, Kramer-Fox R, Brown WT, Shear MK, Hartman N, Kligfield P, et al. Relation between clinical features of the mitral prolapse syndrome and echocardiographically documented mitral valve prolapse. J Am Coll Cardiol 1986;8:763-72.  Back to cited text no. 9
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.  Back to cited text no. 10
Janne d'Othée B, Siebert U, Cury R, Jadvar H, Dunn EJ, Hoffmann U. A systemati review on diagnostic accuracy of CT-based detection of significant coronary artery disease. Eur J Radiol 2008;65:449-61.  Back to cited text no. 11
Raff GL, Gallagher MJ, O'Neill WW, Goldstein JA. Diagnostic accuracy of noninvasive coronary angiography using 64-slice spiral computed tomography. J Am Coll Cardiol 2005;46:552-7.  Back to cited text no. 12
Alkadhi H, Wildermuth S, Bettex DA, Plass A, Baumert B, Leschka S, et al. Mitral regurgitation: Quantification with 16-detector row CT - Initial experience. Radiology 2006;238:454-63.  Back to cited text no. 13
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.  Back to cited text no. 14
Wheatley GH 3 rd , Opie SR, Maas D, Sutherland J, Diethrich EB. Detection of unsuspected mitral valve prolapse using 64 multi-slice computed tomography. Ann Thorac Surg 2007;83:1555.  Back to cited text no. 15
Ghosh N, Al-Shehri H, Chan K, Mesana T, Chan V, Chen L, et al. Characterization of mitral valve prolapse with cardiac computed tomography: Comparison to echocardiographic and intraoperative findings. Int J Cardiovasc Imaging 2012;28:855-63.  Back to cited text no. 16
Feuchtner GM, Alkadhi H, Karlo C, Sarwar A, Meier A, Dichtl W, et al. Cardiac CT angiography for the diagnosis of mitral valve prolapse: Comparison with echocardiography1. Radiology 2010;254:374-83.  Back to cited text no. 17
Shah RG, Novaro GM, Blandon RJ, Wilkinson L, Asher CR, Kirsch J. Mitral valve prolapse: Evaluation with ECG-gated cardiac CT angiography. AJR Am J Roentgenol 2010;194:579-84.  Back to cited text no. 18
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.  Back to cited text no. 19