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J Am Coll Cardiol. 2018 Oct 2;72(14):1600-1609. doi: 10.1016/j.jacc.2018.07.070.

The Mitral Annulus Disjunction Arrhythmic Syndrome.

Author information

1
Center for Cardiological Innovation, Oslo University Hospital, Rikshospitalet, Oslo, Norway; Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway; Institute for Clinical Medicine, University of Oslo, Oslo, Norway. Electronic address: https://twitter.com/LDejgaard.
2
Center for Cardiological Innovation, Oslo University Hospital, Rikshospitalet, Oslo, Norway; Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway; Institute for Clinical Medicine, University of Oslo, Oslo, Norway.
3
Center for Cardiological Innovation, Oslo University Hospital, Rikshospitalet, Oslo, Norway; Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
4
Department of Medicine, Drammen Hospital, Vestre Viken Hospital Trust, Drammen, Norway.
5
Center for Cardiological Innovation, Oslo University Hospital, Rikshospitalet, Oslo, Norway; Division of Radiology and Nuclear Medicine and The Intervention Centre, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
6
Center for Cardiological Innovation, Oslo University Hospital, Rikshospitalet, Oslo, Norway; Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway; Institute for Clinical Medicine, University of Oslo, Oslo, Norway; Institute for Surgical Research, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
7
Center for Cardiological Innovation, Oslo University Hospital, Rikshospitalet, Oslo, Norway; Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway; Institute for Clinical Medicine, University of Oslo, Oslo, Norway; Institute for Surgical Research, Oslo University Hospital, Rikshospitalet, Oslo, Norway. Electronic address: krihauga@medisin.uio.no.

Abstract

BACKGROUND:

Mitral annulus disjunction (MAD) is an abnormal atrial displacement of the mitral valve leaflet hinge point. MAD has been associated with mitral valve prolapse (MVP) and sudden cardiac death.

OBJECTIVES:

The purpose of this study was to describe the clinical presentation, MAD morphology, association with MVP, and ventricular arrhythmias in patients with MAD.

METHODS:

The authors clinically examined patients with MAD. By echocardiography, the authors assessed the presence of MVP and measured MAD distance in parasternal long axis. Using cardiac magnetic resonance (CMR), the authors assessed circumferential MAD in the annular plane, longitudinal MAD distance, and myocardial fibrosis. Aborted cardiac arrest and sustained ventricular tachycardia were defined as severe arrhythmic events.

RESULTS:

The authors included 116 patients with MAD (age 49 ± 15 years; 60% female). Palpitations were the most common symptom (71%). Severe arrhythmic events occurred in 14 (12%) patients. Longitudinal MAD distance measured by CMR was 3.0 mm (interquartile range [IQR]: 0 to 7.0 mm) and circumferential MAD was 150° (IQR: 90° to 210°). Patients with severe arrhythmic events were younger (age 37 ± 13 years vs. 51 ± 14 years; p = 0.001), had lower ejection fraction (51 ± 5% vs. 57 ± 7%; p = 0.002) and had more frequently papillary muscle fibrosis (4 [36%] vs. 6 [9%]; p = 0.03). MVP was evident in 90 (78%) patients and was not associated with ventricular arrhythmia.

CONCLUSIONS:

Ventricular arrhythmias were frequent in patients with MAD. A total of 26 (22%) patients with MAD did not have MVP, and MVP was not associated with arrhythmic events, indicating MAD itself as an arrhythmogenic entity. MAD was detected around a large part of the mitral annulus circumference and was interspersed with normal tissue.

KEYWORDS:

cardiac magnetic resonance; cardiomyopathy; mitral annulus disjunction; mitral regurgitation; mitral valve prolapse; ventricular arrhythmia

PMID:
30261961
DOI:
10.1016/j.jacc.2018.07.070
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