Does Anatomic Phenotype of Mitral Annular Disjunction Impact Survival? An Autopsy-Based Retrospective Study
Controversies have been raised regarding the prevalence and potential clinical significance of mitral annular disjunction (MAD). We aim to address the anatomic characteristics of MAD and their association, if any, on survival. We retrospectively reviewed 1373 consecutive dissected hearts (1017 men,...
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MDPI AG
2021-12-01
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| Series: | Journal of Cardiovascular Development and Disease |
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| Online Access: | https://www.mdpi.com/2308-3425/8/12/174 |
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| author | Nan Zhou Qianhao Zhao Rui Li Da Zheng Yuxi Xiao Danmi Mao Yunyi Wang Jiacheng Yue Kai Zhang Jonathan C. Makielski Jianding Cheng |
| author_facet | Nan Zhou Qianhao Zhao Rui Li Da Zheng Yuxi Xiao Danmi Mao Yunyi Wang Jiacheng Yue Kai Zhang Jonathan C. Makielski Jianding Cheng |
| author_sort | Nan Zhou |
| collection | DOAJ |
| description | Controversies have been raised regarding the prevalence and potential clinical significance of mitral annular disjunction (MAD). We aim to address the anatomic characteristics of MAD and their association, if any, on survival. We retrospectively reviewed 1373 consecutive dissected hearts (1017 men, mean age at death 44.9 ± 0.4 y) and frequently detected MAD (median disjunctional length: 2.0 mm, range: 1.5 mm~8.5 mm), with the prevalence of 92.1% over the entire mitral annulus and 74.9% within the posterior annulus (pMAD). The presence of pMAD was associated with increased all-cause mortality (45 y vs. 49 y, hazard ratio [HR]: 1.28, 95% confidence interval [CI]: 1.11~1.47, <i>p</i> < 0.001), which persisted in the context of cardiovascular diseases (CVDs; 46 y vs. 51 y, HR: 1.33, 95% CI: 1.14~1.56, <i>p</i> < 0.001) but was insignificant in those without CVDs. Compared to those without pMAD, individuals with pMAD affecting the entire posterior annulus or having a mean standardized length of ≥1.78 showed other clinically significant cardiovascular phenotypes, including the enlargement of aortic annular circumferences and a higher occurrence of thoracic aortic aneurysm/dissection. This largest series of autopsies show that MAD is a common phenotype that may exert additive influence on the survival of individuals. It is necessary to establish a precise classification and stratification of MAD. |
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| issn | 2308-3425 |
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| last_indexed | 2024-03-10T03:51:55Z |
| publishDate | 2021-12-01 |
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| series | Journal of Cardiovascular Development and Disease |
| spelling | doaj.art-b13e05883b954da9afef1d77846056d12023-11-23T08:54:56ZengMDPI AGJournal of Cardiovascular Development and Disease2308-34252021-12-0181217410.3390/jcdd8120174Does Anatomic Phenotype of Mitral Annular Disjunction Impact Survival? An Autopsy-Based Retrospective StudyNan Zhou0Qianhao Zhao1Rui Li2Da Zheng3Yuxi Xiao4Danmi Mao5Yunyi Wang6Jiacheng Yue7Kai Zhang8Jonathan C. Makielski9Jianding Cheng10Department of Forensic Pathology, Zhongshan School of Medicine, Sun Yat-sen University, No. 74, Zhongshan 2nd Road, Guangzhou 510080, ChinaDepartment of Forensic Pathology, Zhongshan School of Medicine, Sun Yat-sen University, No. 74, Zhongshan 2nd Road, Guangzhou 510080, ChinaDepartment of Forensic Pathology, Zhongshan School of Medicine, Sun Yat-sen University, No. 74, Zhongshan 2nd Road, Guangzhou 510080, ChinaDepartment of Forensic Pathology, Zhongshan School of Medicine, Sun Yat-sen University, No. 74, Zhongshan 2nd Road, Guangzhou 510080, ChinaDepartment of Forensic Pathology, Zhongshan School of Medicine, Sun Yat-sen University, No. 74, Zhongshan 2nd Road, Guangzhou 510080, ChinaDepartment of Forensic Pathology, Zhongshan School of Medicine, Sun Yat-sen University, No. 74, Zhongshan 2nd Road, Guangzhou 510080, ChinaDepartment of Forensic Pathology, Zhongshan School of Medicine, Sun Yat-sen University, No. 74, Zhongshan 2nd Road, Guangzhou 510080, ChinaDepartment of Forensic Pathology, Zhongshan School of Medicine, Sun Yat-sen University, No. 74, Zhongshan 2nd Road, Guangzhou 510080, ChinaDepartment of Forensic Pathology, Zhongshan School of Medicine, Sun Yat-sen University, No. 74, Zhongshan 2nd Road, Guangzhou 510080, ChinaDivision of Cardiovascular Medicine, Department of Medicine, University of Wisconsin, Madison, WI 53792, USADepartment of Forensic Pathology, Zhongshan School of Medicine, Sun Yat-sen University, No. 74, Zhongshan 2nd Road, Guangzhou 510080, ChinaControversies have been raised regarding the prevalence and potential clinical significance of mitral annular disjunction (MAD). We aim to address the anatomic characteristics of MAD and their association, if any, on survival. We retrospectively reviewed 1373 consecutive dissected hearts (1017 men, mean age at death 44.9 ± 0.4 y) and frequently detected MAD (median disjunctional length: 2.0 mm, range: 1.5 mm~8.5 mm), with the prevalence of 92.1% over the entire mitral annulus and 74.9% within the posterior annulus (pMAD). The presence of pMAD was associated with increased all-cause mortality (45 y vs. 49 y, hazard ratio [HR]: 1.28, 95% confidence interval [CI]: 1.11~1.47, <i>p</i> < 0.001), which persisted in the context of cardiovascular diseases (CVDs; 46 y vs. 51 y, HR: 1.33, 95% CI: 1.14~1.56, <i>p</i> < 0.001) but was insignificant in those without CVDs. Compared to those without pMAD, individuals with pMAD affecting the entire posterior annulus or having a mean standardized length of ≥1.78 showed other clinically significant cardiovascular phenotypes, including the enlargement of aortic annular circumferences and a higher occurrence of thoracic aortic aneurysm/dissection. This largest series of autopsies show that MAD is a common phenotype that may exert additive influence on the survival of individuals. It is necessary to establish a precise classification and stratification of MAD.https://www.mdpi.com/2308-3425/8/12/174mitral annular disjunctionprevalencepoor survivalmorphology |
| spellingShingle | Nan Zhou Qianhao Zhao Rui Li Da Zheng Yuxi Xiao Danmi Mao Yunyi Wang Jiacheng Yue Kai Zhang Jonathan C. Makielski Jianding Cheng Does Anatomic Phenotype of Mitral Annular Disjunction Impact Survival? An Autopsy-Based Retrospective Study Journal of Cardiovascular Development and Disease mitral annular disjunction prevalence poor survival morphology |
| title | Does Anatomic Phenotype of Mitral Annular Disjunction Impact Survival? An Autopsy-Based Retrospective Study |
| title_full | Does Anatomic Phenotype of Mitral Annular Disjunction Impact Survival? An Autopsy-Based Retrospective Study |
| title_fullStr | Does Anatomic Phenotype of Mitral Annular Disjunction Impact Survival? An Autopsy-Based Retrospective Study |
| title_full_unstemmed | Does Anatomic Phenotype of Mitral Annular Disjunction Impact Survival? An Autopsy-Based Retrospective Study |
| title_short | Does Anatomic Phenotype of Mitral Annular Disjunction Impact Survival? An Autopsy-Based Retrospective Study |
| title_sort | does anatomic phenotype of mitral annular disjunction impact survival an autopsy based retrospective study |
| topic | mitral annular disjunction prevalence poor survival morphology |
| url | https://www.mdpi.com/2308-3425/8/12/174 |
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