Mitral annular disjunction; how accurate are we? A cardiovascular MRI study defining risk
Aims: Mitral Annular Disjunction (MAD) refers to embryologic fibrous separation between mitral annular ring and basal left ventricular myocardium. Since its original description, the role of MAD in arrhythmic mitral valve prolapse (MVP) has been the subject of active research. In this study we sough...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2023-12-01
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| Series: | International Journal of Cardiology: Heart & Vasculature |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S235290672300129X |
| _version_ | 1797398590927142912 |
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| author | Nasir Hussain Geeta Bhagia Mark Doyle Geetha Rayarao Ronald B. Williams Robert W.W. Biederman |
| author_facet | Nasir Hussain Geeta Bhagia Mark Doyle Geetha Rayarao Ronald B. Williams Robert W.W. Biederman |
| author_sort | Nasir Hussain |
| collection | DOAJ |
| description | Aims: Mitral Annular Disjunction (MAD) refers to embryologic fibrous separation between mitral annular ring and basal left ventricular myocardium. Since its original description, the role of MAD in arrhythmic mitral valve prolapse (MVP) has been the subject of active research. In this study we sought to assess prognostic and imaging characteristics of MVP patients with and without underlying MAD. Methods and results: Patients with posterior or bi-leaflet MVP were retrospectively identified via a review of all patients referred to our cardiac magnetic resonance (CMR) imaging laboratory from January 2015 to May 2022. MVP patients were further stratified by underlying MAD status. A total of 100 MVP patients undergoing CMR imaging (52 MVP patients with posterior MAD) were retrospectively identified with female comprising 55 % of the cohort. MVP patients with MAD were more likely to have an abnormal basal inferolateral/ papillary muscles LGE (51 % vs 21 %, p < 0.01). Posterior MAD longitudinal disjunction gap in ‘mm’ was a predictor of ventricular tachycardia (VT) [1.29, p = 0.01)]. Using ROC curve analysis, a disjunction gap of ≥ 4 mm was predictive of VT (AUC-0.71, p < 0.01), and incorporation of LGE in ROC model further improved AUC to 0.78 confirmed via Akaike information criterion (p < 0.01). Conclusion: Abnormal LGE involving basal inferolateral myocardium and papillary muscles may provide etiologic substrate for arrythmia in MVP patients. |
| first_indexed | 2024-03-09T01:27:46Z |
| format | Article |
| id | doaj.art-ce766b44189842aeb52f7d3dcc8e6691 |
| institution | Directory Open Access Journal |
| issn | 2352-9067 |
| language | English |
| last_indexed | 2024-03-09T01:27:46Z |
| publishDate | 2023-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | International Journal of Cardiology: Heart & Vasculature |
| spelling | doaj.art-ce766b44189842aeb52f7d3dcc8e66912023-12-10T06:16:31ZengElsevierInternational Journal of Cardiology: Heart & Vasculature2352-90672023-12-0149101298Mitral annular disjunction; how accurate are we? A cardiovascular MRI study defining riskNasir Hussain0Geeta Bhagia1Mark Doyle2Geetha Rayarao3Ronald B. Williams4Robert W.W. Biederman5Allegheny Health Network, Allegheny General Hospital, Center for Cardiovascular MRI, Pittsburgh, PA 15212, USA; Wilson Medical Center, United Health Service, Johnson City, NY 13790, USA; Corresponding author at: Allegheny Health Network, Allegheny General Hospital, Department of Advanced, Cardiovascular MRI Imaging, 320 E North Ave, Pittsburgh, PA 15212, USA.Allegheny Health Network, Allegheny General Hospital, Center for Cardiovascular MRI, Pittsburgh, PA 15212, USA; Benefis Health System, Great Falls, MT 59404, USAAllegheny Health Network, Allegheny General Hospital, Center for Cardiovascular MRI, Pittsburgh, PA 15212, USAAllegheny Health Network, Allegheny General Hospital, Center for Cardiovascular MRI, Pittsburgh, PA 15212, USAAllegheny Health Network, Allegheny General Hospital, Center for Cardiovascular MRI, Pittsburgh, PA 15212, USAAllegheny Health Network, Allegheny General Hospital, Center for Cardiovascular MRI, Pittsburgh, PA 15212, USA; West Virginia University, Morgantown, WV 26506, USA; Medical University of South Carolina, Charleston, SC 29425, USAAims: Mitral Annular Disjunction (MAD) refers to embryologic fibrous separation between mitral annular ring and basal left ventricular myocardium. Since its original description, the role of MAD in arrhythmic mitral valve prolapse (MVP) has been the subject of active research. In this study we sought to assess prognostic and imaging characteristics of MVP patients with and without underlying MAD. Methods and results: Patients with posterior or bi-leaflet MVP were retrospectively identified via a review of all patients referred to our cardiac magnetic resonance (CMR) imaging laboratory from January 2015 to May 2022. MVP patients were further stratified by underlying MAD status. A total of 100 MVP patients undergoing CMR imaging (52 MVP patients with posterior MAD) were retrospectively identified with female comprising 55 % of the cohort. MVP patients with MAD were more likely to have an abnormal basal inferolateral/ papillary muscles LGE (51 % vs 21 %, p < 0.01). Posterior MAD longitudinal disjunction gap in ‘mm’ was a predictor of ventricular tachycardia (VT) [1.29, p = 0.01)]. Using ROC curve analysis, a disjunction gap of ≥ 4 mm was predictive of VT (AUC-0.71, p < 0.01), and incorporation of LGE in ROC model further improved AUC to 0.78 confirmed via Akaike information criterion (p < 0.01). Conclusion: Abnormal LGE involving basal inferolateral myocardium and papillary muscles may provide etiologic substrate for arrythmia in MVP patients.http://www.sciencedirect.com/science/article/pii/S235290672300129XMitral annular disjunctionMitral valve prolapseVentricular tachycardia |
| spellingShingle | Nasir Hussain Geeta Bhagia Mark Doyle Geetha Rayarao Ronald B. Williams Robert W.W. Biederman Mitral annular disjunction; how accurate are we? A cardiovascular MRI study defining risk International Journal of Cardiology: Heart & Vasculature Mitral annular disjunction Mitral valve prolapse Ventricular tachycardia |
| title | Mitral annular disjunction; how accurate are we? A cardiovascular MRI study defining risk |
| title_full | Mitral annular disjunction; how accurate are we? A cardiovascular MRI study defining risk |
| title_fullStr | Mitral annular disjunction; how accurate are we? A cardiovascular MRI study defining risk |
| title_full_unstemmed | Mitral annular disjunction; how accurate are we? A cardiovascular MRI study defining risk |
| title_short | Mitral annular disjunction; how accurate are we? A cardiovascular MRI study defining risk |
| title_sort | mitral annular disjunction how accurate are we a cardiovascular mri study defining risk |
| topic | Mitral annular disjunction Mitral valve prolapse Ventricular tachycardia |
| url | http://www.sciencedirect.com/science/article/pii/S235290672300129X |
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