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Mitral annulus disjunction in consecutive patients undergoing cardiovascular magnetic resonance: Where is the boundary between normality and disease?
Figliozzi, Stefano; Stankowski, Kamil; Tondi, Lara; Catapano, Federica; Gitto, Mauro; Lisi, Costanza; Bombace, Sara; Olivieri, Marzia; Cannata, Francesco; Fazzari, Fabio; Bragato, Renato Maria; Georgiopoulos, Georgios; Masci, Pier-Giorgio; Monti, Lorenzo; Condorelli, Gianluigi; Francone, Marco.
Afiliação
  • Figliozzi S; IRCCS Humanitas Research Hospital, Via Alessandro Manzoni, 56, Rozzano, Milano, Italy. Electronic address: stefanofigliozzi@hotmail.it.
  • Stankowski K; IRCCS Humanitas Research Hospital, Via Alessandro Manzoni, 56, Rozzano, Milano, Italy; Department of Biomedical Sciences, Humanitas University, Via Alessandro Manzoni, 56, Pieve Emanuele, Milano, Italy.
  • Tondi L; Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, San Donato Milanese, Milano, Italy.
  • Catapano F; IRCCS Humanitas Research Hospital, Via Alessandro Manzoni, 56, Rozzano, Milano, Italy; Department of Biomedical Sciences, Humanitas University, Via Alessandro Manzoni, 56, Pieve Emanuele, Milano, Italy.
  • Gitto M; IRCCS Humanitas Research Hospital, Via Alessandro Manzoni, 56, Rozzano, Milano, Italy; Department of Biomedical Sciences, Humanitas University, Via Alessandro Manzoni, 56, Pieve Emanuele, Milano, Italy.
  • Lisi C; IRCCS Humanitas Research Hospital, Via Alessandro Manzoni, 56, Rozzano, Milano, Italy; Department of Biomedical Sciences, Humanitas University, Via Alessandro Manzoni, 56, Pieve Emanuele, Milano, Italy.
  • Bombace S; IRCCS Humanitas Research Hospital, Via Alessandro Manzoni, 56, Rozzano, Milano, Italy; Department of Biomedical Sciences, Humanitas University, Via Alessandro Manzoni, 56, Pieve Emanuele, Milano, Italy.
  • Olivieri M; Department of Biomedical Sciences, Humanitas University, Via Alessandro Manzoni, 56, Pieve Emanuele, Milano, Italy.
  • Cannata F; IRCCS Humanitas Research Hospital, Via Alessandro Manzoni, 56, Rozzano, Milano, Italy.
  • Fazzari F; IRCCS Humanitas Research Hospital, Via Alessandro Manzoni, 56, Rozzano, Milano, Italy.
  • Bragato RM; IRCCS Humanitas Research Hospital, Via Alessandro Manzoni, 56, Rozzano, Milano, Italy.
  • Georgiopoulos G; Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece; School of Biomedical Engineering and Imaging Sciences-Faculty of Life Sciences and Medicine, King's College London, London, UK.
  • Masci PG; School of Biomedical Engineering and Imaging Sciences-Faculty of Life Sciences and Medicine, King's College London, London, UK.
  • Monti L; IRCCS Humanitas Research Hospital, Via Alessandro Manzoni, 56, Rozzano, Milano, Italy.
  • Condorelli G; IRCCS Humanitas Research Hospital, Via Alessandro Manzoni, 56, Rozzano, Milano, Italy; Department of Biomedical Sciences, Humanitas University, Via Alessandro Manzoni, 56, Pieve Emanuele, Milano, Italy.
  • Francone M; IRCCS Humanitas Research Hospital, Via Alessandro Manzoni, 56, Rozzano, Milano, Italy; Department of Biomedical Sciences, Humanitas University, Via Alessandro Manzoni, 56, Pieve Emanuele, Milano, Italy.
J Cardiovasc Magn Reson ; 26(2): 101056, 2024 Jul 04.
Article em En | MEDLINE | ID: mdl-38971502
ABSTRACT

BACKGROUND:

The presence of mitral annulus disjunction (MAD) has been considered a high-risk feature for sudden cardiac death based on selected study populations. We aimed to assess the prevalence of MAD in consecutive patients undergoing clinically indicated cardiovascular magnetic resonance (CMR), its association with ventricular arrhythmias, mitral valve prolapse (MVP), and other CMR features.

METHODS:

This single-center retrospective study included consecutive patients referred to CMR at our institution between June 2021 and November 2021. MAD was defined as a ≥1 mm displacement between the left atrial wall-mitral valve leaflet junction and the left ventricular wall during end-systole. MAD extent was defined as the maximum longitudinal displacement. Associates of MAD were evaluated at univariable and multivariable regression analysis. The study endpoint, a composite of (aborted) sudden cardiac death, unexplained syncope, and sustained ventricular tachycardia, was evaluated at a 12-month follow-up.

RESULTS:

Four hundred and forty-one patients 55 ± 18 years, 267/441 (61%) males) were included, and 29/441 (7%) had MVP. The prevalence of MAD ≥1 mm, 4 mm, and 6 mm was 214/441 (49%), 63/441 (14%), and 15/441 (3%), respectively. Patients with MVP showed a higher prevalence of MAD greater than 1 mm (26/29 (90%) vs 118/412 (46%)); p < 0.001), 4 mm (14/29 (48%) vs 49/412 (12%)); p < 0.001), and 6 mm (3/29 (10%) vs 12/412 (3%)); p = 0.03), and a greater MAD extent (4.2 mm, 3.0-5.7 mm vs 2.8 mm, 1.9-4.0 mm; p < 0.001) compared to patients without MVP. MVP was the only morpho-functional abnormality associated with MAD at multivariable analysis (p < 0.001). A high burden of ventricular ectopic beats at baseline Holter-electrocardiogram was associated with MAD ≥4 mm and MAD extent (p < 0.05). The presence of MAD ≥1 mm (0.9% vs 1.8%; p = 0.46), MAD ≥4 mm (1.6% vs 1.3%; p = 0.87), or MVP (3.5% vs 1.2%; p = 0.32) were not associated with the study endpoint, whereas patients with MAD ≥6 mm showed a trend toward a higher likelihood of the study endpoint (6.7% vs 1.2%; p = 0.07).

CONCLUSION:

MAD of limited severity was common in consecutive patients undergoing CMR. Patients with MVP showed higher prevalence and greater extent of MAD. Extended MAD was rarer and showed association with ventricular arrhythmias at baseline. The mid-term prognosis of MAD seems benign; however, prospective studies are warranted to search for potential "malignant MAD extents" to improve patients' risk stratification.
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Texto completo: 1 Base de dados: MEDLINE Idioma: En Ano de publicação: 2024 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Idioma: En Ano de publicação: 2024 Tipo de documento: Article