Discrimination between fibroelastic deficiency and Barlow disease using parameters of mitral annulus derived from real-time three-dimensional echocardiography

Background: Discrimination between fibroelastic deficiency (FED) and Barlow disease (BD) is crucial for decision making in mitral valve surgery as BD is a more complex lesion demanding high surgical skill and experience. In our study we focused on the differentiation of FED from BD using three-dimensional (3D) echocardiographic parameters of the mitral annulus assessed by the mitral valve quantification (MVQ) program.

Methods: We examined 90 patients (30 women) with FED and BD aged 37-76 years. The following parameters of the mitral annulus were assessed using the MVQ program: bicommissural and anteroposterior diameter of the mitral annulus, 3D annulus circumference, minimal surface spanning the annulus, and mitral annulus height. The study group was subdivided into 2 subgroups according to the intraoperative findings: the first subgroup comprised 60 individuals (19 women) with FED and the second subgroup comprised 30 patients (11 women) with BD. The discrimination between patients with BD and FED was carried out by univariate as well as multivariate statistical methods.

Results: BD and FED patients differed highly significantly in all parameters of the mitral annulus (t test), values of all parameters in BD being higher. In the classification tree modeling, the diagnoses were completely separated by a single parameter-mitral annulus height-with a cutoff value of 6.55 mm. This value and higher stands for BD. Multivariate analysis treating all the variables showed similar results, so the use of a single indicator variable is preferable.

Conclusion: The only parameter-mitral annulus height-can be used for discrimination between Barlow disease and fibroelastic deficiency.