Mitral annulus disjunction in consecutive patients undergoing cardiovascular magnetic resonance: Where is the boundary between normality and disease?

IF 4.2 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS
Stefano Figliozzi, Kamil Stankowski, Lara Tondi, Federica Catapano, Mauro Gitto, Costanza Lisi, Sara Bombace, Marzia Olivieri, Francesco Cannata, Fabio Fazzari, Renato Maria Bragato, Georgios Georgiopoulos, Pier-Giorgio Masci, Lorenzo Monti, Gianluigi Condorelli, Marco Francone
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引用次数: 0

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.

接受心脏磁共振检查的连续患者的二尖瓣瓣环脱节:正常与疾病的界限在哪里?
背景:根据选定的研究人群,二尖瓣环脱节(MAD)的存在被认为是心脏性猝死的高危特征。我们的目的是评估二尖瓣环脱节(MAD)在接受临床指示的心脏磁共振(CMR)检查的连续患者中的患病率,以及其与室性心律失常、二尖瓣脱垂(MVP)和其他 CMR 特征的关联:这项单中心回顾性研究纳入了 2021 年 6 月至 2021 年 11 月期间本机构转诊至 CMR 的连续患者。MAD的定义是在收缩末期左心房壁-二尖瓣瓣叶交界处与左心室壁之间的位移≥1毫米。MAD 范围定义为最大纵向位移。通过单变量和多变量回归分析评估了 MAD 的相关性。研究终点包括(中止的)心脏性猝死、原因不明的晕厥和持续性室性心动过速:共纳入 441 名患者(55±18 岁,61% 为男性),其中 29 人(7%)患有 MVP。MAD≥1毫米、4毫米和6毫米的患病率分别为214人(49%)、63人(14%)和15人(3%)。MVP患者MAD大于1毫米的发生率更高(90%对46%;P结论:在接受CMR检查的连续患者中,有限实体的MAD很常见。MVP患者的MAD发生率更高,范围更大。扩展型 MAD 较为罕见,并与基线时的室性心律失常有关。MAD的中期预后似乎是良性的,但有必要进行前瞻性研究,寻找潜在的 "恶性MAD范围",以改善患者的风险分层。
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来源期刊
CiteScore
10.90
自引率
12.50%
发文量
61
审稿时长
6-12 weeks
期刊介绍: Journal of Cardiovascular Magnetic Resonance (JCMR) publishes high-quality articles on all aspects of basic, translational and clinical research on the design, development, manufacture, and evaluation of cardiovascular magnetic resonance (CMR) methods applied to the cardiovascular system. Topical areas include, but are not limited to: New applications of magnetic resonance to improve the diagnostic strategies, risk stratification, characterization and management of diseases affecting the cardiovascular system. New methods to enhance or accelerate image acquisition and data analysis. Results of multicenter, or larger single-center studies that provide insight into the utility of CMR. Basic biological perceptions derived by CMR methods.
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