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Assessment of aortic and mitral annuli dynamics during the cardiac cycle using speckle tracking echocardiography


The aims of this study were i) to evaluate mitral and aortic annuli excursion, and aortomitral angle (AMA) during the cardiac cycle in healthy adults using two-dimensional speckle tracking echocardiography, ii) to assess two annuli dynamics and coupling behaviors as an integral, and iii) to detect the relation between two annuli and left ventricular ejection fraction (LVEF). A total of 74 healthy adults underwent transthoracic echocardiography. In the parasternal long-axis view, a number of points were extracted, including right coronary aortic annular, aortomitral fibrous junction, and posterior mitral annular points. The annuli excursion and AMA were measured using a speckle tracking-derived software during the cardiac cycle. During the isovolumic contraction and the isovolumic relaxation phase, annuli excursion and AMA remain stable for a short time. During the systole, annuli excursion increased sharply to the maximum, while AMA narrowed quickly to the minimum value. During the diastole, there are three patterns of decrease in annuli excursion and AMA expansion in different phases. The annuli excursion of three points correlates well with the LVEF (right coronary aortic annulus excursion, r=0.71, P<0.05; non-coronary aortic annulus excursion, r=0.70, P<0.05; posterior mitral annulus excursion, r=0.82, P<0.05). Moreover, there are positive correlations between annuli excursion and the variation of AMA (r=0.60, P<0.05). The annuli excursion and AMA have various regular patterns in healthy adults. The interactions of mitral and aortic annuli correlate with the left ventricular function. Our findings may have relevance to the evaluation of left ventricular function and presurgical planning of patients with valvular diseases.


  1. Holen J & Nitter-Hauge S 1977 Evaluation of obstructive characteristics of mitral disk valve implants with ultrasound Doppler techniques. Acta Medica Scandinavica 201 429–434. doi:10.1111/j.0954-6820.1977.tb15725.x

    Article  CAS  Google Scholar 

  2. Goetz WA, Lansac E, Lim HS, Stevens SA, Weber PA & Duran CMG 2006 Kinking of the atrioventricular plane during the cardiac cycle. Asian Cardiovascular & Thoracic Annals 14 394–398. doi:10.1177/021849230601400509

    Article  Google Scholar 

  3. Flachskampf FA, Chandra S, Gadipatti A, Levine RA, Weyman AE, Ameling W, Hanrath P & Thomas JD 2000 Analysis of shape and motion of the mitral annulus in subjects with and without cardiomyopathy by echocardiographic 3-dimensional reconstruction. Journal of the American Society of Echocardiography 13 277–287. doi:10.1067/mje.2000.103878

    Article  CAS  Google Scholar 

  4. DeCara JM, Toledo E, Salgo IS, Lammertin G, Weinert L & Lang RM 2005 Evaluation of left ventricular systolic function using automated angle-independent motion tracking of mitral annular displacement. Journal of the American Society of Echocardiography 18 1266–1269. doi:10.1016/j.echo.2005.07.018

    Article  Google Scholar 

  5. Tsang W, Ahmad H, Patel AR, Sugeng L, Salgo IS, Weinert L, Mor-Avi V & Lang RM 2010 Rapid estimation of left ventricular function using echocardiographic speckle-tracking of mitral annular displacement. Journal of the American Society of Echocardiography 23 511–515. doi:10.1016/j.echo.2010.03.003

    Article  Google Scholar 

  6. Nakai H, Takeuchi M, Yoshitani H, Kaku K, Haruki N & Otsuji Y 2010 Pitfalls of anatomical aortic valve area measurements using two-dimensional transesophageal echocardiography and the potential of three-dimensional transesophageal echocardiography. European Journal of Echocardiography 111 369–376. doi:10.1093/ejechocard/jep220

    Article  Google Scholar 

  7. Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, Picard MH, Roman MJ, Seward J, Shanewise JS et al 2005 Recommendations for chamber quantification: a report from the American Society of Echocardiography’s Guidelines and Standards. Journal of the American Society of Echocardiography 18 1440–1463. doi:10.1016/j.echo.2005.10.005

    Article  Google Scholar 

  8. Silbiger JJ & Bazaz R 2009 Contemporary insights into the functional anatomy of the mitral valve. American Heart Journal 158 887–895. doi:10.1016/j.ahj.2009.10.014

    Article  Google Scholar 

  9. Timek TA, Green GR, Tibayan FA, Lai DT, Rodriguez F, Liang D, Daughters GT, Ingels NB Jr & Miller DC 2003 Aortomitral annular dynamics. Annals of Thoracic Surgery 76 1944–1950. doi:10.1016/S0003-4975(03)01078-6

    Article  Google Scholar 

  10. Veronesi F, Caiani EG, Sugeng L, Fusini L, Tamborini G, Alamanni F, Pepi M & Lang RM 2012 Effect of mitral valve repair on mitral-aortic coupling: a real-time three-dimensional transesophageal echocardiography study. Journal of the American Society of Echocardiography 25 524–531. doi:10.1016/j.echo.2012.02.002

    Article  Google Scholar 

  11. Sughimoto K, Takahara Y, Mogi K, Liu H & Yamazaki K 2010 Annular excursion contributes to efficient cardiac output: a three-dimensional echocardiographic approach. Journal of Heart Valve Disease 19 244–248.

    PubMed  Google Scholar 

  12. Carlsson M, Ugander M, Mosén H, Buhre T & Arheden H 2007 Atrioventricular plane displacement is the major contributor to left ventrasicular pumping in healthy adults, athletes, and patients with dilated cardiomyopathy. American Journal of Physiology. Heart and Circulatory Physiology 292 H1452–H1459. doi:10.1152/ajpheart.01148.2006

    Article  CAS  Google Scholar 

  13. Radermecker M, Canivet JL, Lancellotti P & Limet R 2005 The usual causes of left ventricular outflow tract obstruction below the aortic valve in normal ventriculoarterial connection: review of the physiopathology and surgical implications. Acta Chirurgica Belgica 105 475–481.

    Article  CAS  Google Scholar 

  14. Omoto R, Matsumura M, Asano H, Kyo S, Takamoto S, Yokote Y & Wong M 1986 Doppler ultrasound examination of prosthetic function and ventricular blood flow after mitral valve replacement. Herz 11 346–350.

    CAS  PubMed  Google Scholar 

  15. Mihaileanu S, Marino JP, Chauvaud S, Perier P, Forman J, Vissoat J, Julien J, Dreyfus G, Abastado P & Carpentier A 1988 Left ventricular outflow obstruction after mitral valve repair (Carpentier’s Technique): proposed mechanisms of disease. Circulation 78 (Suppl I) I78–84.

    CAS  PubMed  Google Scholar 

  16. Gray, Henry 1918. The Heart. Gray’s Anatomy 20th edition ch V, 4b, pp 526–539. Ed WH Lewis. London: Longmans. ISBN 613-0-24743-5.

  17. Torrent-Guasp F, Buckberg GD, Clemente C, Cox JL, Coghlan HC & Gharib M 2001 The structure and function of the helical heart and its buttress wrapping. I. The normal macroscopic structure of the heart. Seminars in Thoracic and Cardiovascular Surgery 13 301–319.

    Article  CAS  Google Scholar 

  18. Bardia A & Subramaniam B 2013 Systolic anterior motion: an illustrative case and discussion of management strategy. Journal of Perioperative Echocardiography 1 62–65. doi:10.5005/jp-journals-10034-1010

    Article  Google Scholar 

  19. Ionasec RI, Voigt I, Georgescu B, Wang Y, Houle H, Hornegger J, Navab N & Comaniciu D 2009 Personalized modeling and assessment of the aortic–mitral coupling from 4D TEE and CT. Medical Image Computing and Computer-Assisted Intervention 12 767–775.

    PubMed  Google Scholar 

  20. Lansac E, Lim KH, Shomura Y, Goetz WA, Lim HS, Rice NT, Saber H & Duran CM 2002 Dynamic balance of the aortomitral junction. Journal of Thoracic and Cardiovascular Surgery 123 911–918. doi:10.1067/mtc.2002.121286

    Article  Google Scholar 

  21. Jensen MO, Jensen H, Smerup M, Levine RA, Yoganathan M, Nygaard H, Hasenkam JM & Nielsen SL 2008 Saddle-shaped mitral valve annuloplasty rings experience lower forces compared with flat rings. Circulation 118 (Suppl 14) S250–S255. doi:10.1161/CIRCULATIONAHA.107.746776

    PubMed  Google Scholar 

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Correspondence to Li Rao MD PhD.

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Bai, W., Li, H., Tang, H. et al. Assessment of aortic and mitral annuli dynamics during the cardiac cycle using speckle tracking echocardiography. Echo Res Pract 1, 11–16 (2014).

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  • 2D speckle-tracking echocardiography
  • left ventricular ejection fraction
  • annulus excursion
  • aortomitral angle