P500Normative reference values for mitral annular dimensions using two-dimension echocardiography in a population based study of older subjects

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Purpose: Only limited data from small trans-thoracic studies are available providing normal ranges of mitral annular (MA) dimensions using 2D echocardiography. Commonly used values are derived from peri-operative studies that compare pre and post-operative outcomes but do not provide normal ranges. A dilated or abnormally shaped mitral annulus is a common cause of mitral valve (MV) regurgitation and normal ranges would be useful in serial MV assessment.Methods: A total of 480 consecutive subjects over the age of 60 were randomly recruited from the community as part of a screening project within South Birmingham. MA dimensions in end systole and end diastole were evaluated in the para-sternal long-axis (PLAX) (anterior-posterior diameter), para-sternal short-axis (PSAX) (anterolateral-posteromedial diameter), and apical 4-chamber (oblique) views. MV tenting area and tenting distance were also assessed in PLAX.Results: Of the 480 patients recruited, 5 with moderate to severe mitral regurgitation were excluded from the final analysis. Mean age of the subjects was 70 years (60-88; SD=7.2), the majority were female (56%), with mean weight (69.5±12.9kg) and height (1.6+0.5m). Mean values (with Standard Deviation) of various measurements are given in Table.Conclusions: Although 3D echocardioraphy is recognised as the gold standard, most departments require 2D echocardiography ranges for accurate MV assessment. The reference ranges presented from our study may help in distinguishing normal from pathological findings and also in planning for surgical MV repair.

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