The Complexity of the Relationship Between Mitral and Aortic Valve Annular Dimensions in the Same Healthy Adults: Detailed Insights from the Three-Dimensional Speckle-Tracking Echocardiographic MAGYAR-Healthy Study

<b>Introduction.</b> Although the aortic valve and mitral valve differ significantly in structure, function, and location, they both play a significant role in left ventricular (LV) function. The aim of the current study was to analyze the relationship between the mitral valve annulus (MVA) and the aortic valve annulus (AVA), as measured by three-dimensional speckle-tracking echocardiography (3DSTE) in the same healthy individuals with average or smaller/larger annular diameters (Ds), areas (As), and perimeters (Ps) in end-diastole (D) and end-systole (S). <b>Methods.</b> This study comprised 134 healthy adult participants with a mean age of 31.0 (16.0) years (73 males). A complete medical investigation included physical examination, laboratory tests, standard 12-lead electrocardiography, and two-dimensional Doppler echocardiography supplemented with 3DSTE. <b>Results.</b> Almost all end-diastolic and end-systolic MVA dimensions increased significantly with enlarging MVA. Similarly, as MVA-D-D and MVA-P-D increased, nearly all end-diastolic and end-systolic AVA dimensions exhibited a positive trend. Lower-than-average MVA-A-D was associated with a trend toward higher AVA dimensions (excluding AVA-P-D) compared to the mean MVA-A-D; conversely, higher-than-average MVA-A-D was also associated with increased AVA dimensions. AVA perimeter values were notably higher than those recorded in the lower-than-average MVA-A-D subgroup. In subjects with lower-than-average end-diastolic MVA dimensions, a non-significantly higher proportion of larger end-systolic AVA was observed relative to end-diastolic AVA. While AVA dimensions remained unchanged despite increasing MVA-D-S, a positive trend in AVA dimensions-reaching statistical significance for certain parameters-was observed alongside increasing MVA-A-S and MVA-P-S. In subjects with lower-than-average end-systolic MVA dimensions, there was a non-significantly higher prevalence of larger end-systolic AVA compared to end-diastolic AVA. Furthermore, nearly all end-diastolic and end-systolic AVA dimensions increased significantly with increasing AVA. Increases in AVA-D-D, AVA-A-D, and AVA-P-D were generally accompanied by a trend toward higher end-diastolic and end-systolic MVA dimensions; however, MVA-D-S peaked in the presence of lower-than-average end-diastolic AVA dimensions. In subjects with lower-than-average end-diastolic AVA, a non-significantly higher proportion of larger end-systolic AVA was noted compared to end-diastolic AVA. Notably higher MVA parameters were observed in the presence of mean AVA-D-S and AVA-A-S compared to their lower-than-average counterparts. Finally, end-diastolic MVA parameters showed a positive trend with increasing AVA-P-S, and subjects with higher-than-average end-systolic AVA dimensions demonstrated a significantly higher proportion of larger end-systolic AVA compared to end-diastolic AVA. <b>Conclusions.</b> There is a strong and complex association between the dimensions of the MVA and AVA, as assessed by 3DSTE, when measured simultaneously in the same healthy adults.