Mitral annular disjunction in patients with severe aortic stenosis: Extent and reproducibility of measurements with computed tomography.
Eur J Radiol Open
; 8: 100335, 2021.
Article
in En
| MEDLINE
| ID: mdl-33748350
ABSTRACT
OBJECTIVES:
To determine with CT the prevalence and extent of mitral annular disjunction (MAD) in patients undergoing transcatheter aortic valve replacement (TAVR) and its association with mitral valve disease and arrhythmia.METHODS:
We retrospectively evaluated 408 patients (median age, 82 years; 186 females) with severe aortic stenosis undergoing ECG-gated cardiac CT with end-systolic data acquisition. Baseline and follow-up data were collected in the context of a national registry. Two blinded, independent observers evaluated the presence of MAD on multi-planar reformations. Maximum MAD distance (left atrial wall-mitral leaflet junction to left ventricular myocardium) and circumferential extent of MAD were assessed on CT using dedicated post-processing software. Associated mitral valve disease was determined with echocardiography.RESULTS:
7.8 % (32/408) of patients with severe aortic stenosis had MAD. The maximum MAD was 3.5â¯mm (interquartile range 3.0-4.0â¯mm). The circumferential extent of MAD comprised 34⯱â¯15 % of the posterior and 26⯱â¯12 % of the entire mitral annulus. Intra- and interobserver agreement for the detection of MAD on CT were excellent (kappa 0.90⯱â¯0.02 and 0.92⯱â¯0.02). Mitral regurgitation (pâ¯=â¯1.00) and severe mitral annular calcification (pâ¯=â¯0.29) were similarly prevalent in MAD and non-MAD patients. Significantly more patients with MAD (6/32; 19 %) had mitral valve prolapse compared to those without (6/376; 2 %; pâ¯<â¯0.001). MAD was not associated with arrhythmia before and after TAVR (pâ¯>â¯0.05).CONCLUSIONS:
Using CT, MAD was found in 7.8 % of patients with severe aortic stenosis, with a higher prevalence in patients with mitral valve prolapse. We found no association of MAD with arrhythmia before or after TAVR.
CT, computed tomography; Computed tomography; ECG, electrocardiogram; IQR, inter-quartile range; MADmitral, annular disjunction; MR, mitral regurgitation; Mitral annular disjunction; Mitral valve; Mitral valve prolapse; TAVR, transcatheter aortic valve replacement; Transcatheter aortic valve replacement
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Type of study:
Risk_factors_studies
Language:
En
Journal:
Eur J Radiol Open
Year:
2021
Document type:
Article
Affiliation country:
Switzerland