Usefulness of 3-Tesla Cardiac Magnetic Resonance to Detect Mitral Annular Disjunction in Patients With Mitral Valve Prolapse
Section snippets
Methods
The study was conducted at the Monaco Heart center, Monaco. We, retrospectively evaluated 89 patients with echocardiographic diagnosis of MVP, consecutively referred for CMR assessment of MR, over a 24-months period. Exclusion criteria were more than mild aortic stenosis, aortic regurgitation or mitral stenosis, intracardiac shunt, and standard contraindications to CMR. Institutional review board approval was obtained before conducting the study. The study was conducted in accordance with
Results
Eighty-nine patients (63 women; mean age 64 ± 13) with MVP were consecutively referred for CMR assessment of MR. Baseline demographic and clinical characteristics of the 89 patients are displayed in Table 1. MAD was diagnosed in 35% (31 of 89) of MVP patients, measuring 8 ± 4 mm [2 to 16 mm]. A typical curling motion (mean length 4 ± 4 mm) was found in 64%, considered severe (≥3.5 mm) in 75%. MAD was more frequent in MMVP than in FED (60% vs 14%; p <0.0001). Ventricular arrhythmia was
Discussion
Our study using 3-Tesla CMR shows that MAD was present in about 1/3 of MVP patients, more frequently in MMVP than in FED, independently of MR severity. Enlarged MA and basal LV diameters, ventricular arrhythmias and papillary muscle fibrosis were associated with the presence of MAD. Comprehensive CMR study of MVP should include a careful description of MAD, alongside with other risk factors of ventricular arrhythmia such as focal fibrosis, irrespectively of MR severity.
Prevalence of MAD in the
Disclosures
The authors have no conflicts of interest to disclose.
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Cited by (41)
Ventricular arrhythmia and sudden cardiac death
2024, Archives des Maladies du Coeur et des Vaisseaux - PratiqueArrhythmic mitral annular disjunction syndrome: An underestimated cause of sudden cardiac death
2022, International Journal of CardiologyPrevalence and prognostic impact of mitral annular disjunction in patients with STEMI – A cardiac magnetic resonance study
2022, Journal of CardiologyCitation Excerpt :This discrepancy in comparison to our data could be attributed to the higher spatial resolution and the possibility of three-dimensional reconstruction via CT compared to CMR, which also results in a higher mean MAD-extent in our study (4.6 ± 1.7 mm). So far, only two works reported the prevalence of MAD using CMR – an abstract by Christiansen et al. in 2010 found MAD in 58 % of patients with MVP [22]; a study by Essayagh discovered MAD in even 65 % of MVP-patients [23]; both studies did not define a “minimum extent” as threshold for the diagnosis of MAD. Mostly due to the additional prolapse (which seemingly is accompanied by larger disjunction lengths [24]), both studies showed a higher MAD-prevalence and distinctly larger MAD-lengths (14 mm and 8 mm, respectively) than we found in our study.
Comprehensive mitral valve prolapse assessment by cardiovascular MRI
2022, Clinical RadiologyCitation Excerpt :As a routine evaluation of MAD, it would be important to span the entire MV annulus circumference as the MAD can extend differently along the valve ring.14,17 Although several studies have suggested that the greater the extent of MAD, the higher the arrhythmic risk is, there is no consensus on whether a specific cut-off in MAD length is associated with malignant ventricular arrhythmias.10,11,17,22 The motion of the mitral annulus is passive and determined by the contraction and relaxation of adjacent atrial and ventricular musculature.
Mitral Annular Disjunction of Degenerative Mitral Regurgitation: Three-Dimensional Evaluation and Implications for Mitral Repair
2022, Journal of the American Society of EchocardiographyCitation Excerpt :These postoperative changes confirm that the preoperative appearance is indeed misleading and may cause underestimation of the consequences of MR on the left ventricle. Whether MAD area, which may be associated with fibrosis on magnetic resonance imaging15 and histology,13 might affect LV function will require long-term postoperative studies. Importantly, MV repair is a major determinant of clinical outcomes in patients with MVP and severe MR,7,16 and our study shows that the presence of MAD does not impair the feasibility of mitral repair in these patients.