Prevalence of Diastolic and Systolic Mitral Annular Disjunction in Patients With Mitral Valve Prolapse

IF 5.4 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of the American Society of Echocardiography Pub Date : 2025-01-01 DOI:10.1016/j.echo.2024.10.004

Giorgio Fiore MD , Vincenzo Rizza MD , Giacomo Ingallina MD , Francesco Ancona MD , Stefano Stella MD , Federico Biondi MD , Paola Cunsolo MD , Carlo Gaspardone MD , Davide Romagnolo MD , Annamaria Tavernese MD , Martina Belli MD , Davide Margonato MD , Anna Palmisano MD , Antonio Esposito MD , Francesco Maisano MD , Francesco Fulvio Faletra MD , Eustachio Agricola MD

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引用次数: 0

Abstract

Backgrounds

Mitral annular disjunction (MAD) is commonly evaluated at end systole. However, a systolic-only disjunction is merely apparent, and 2 distinct phenotypes have been identified: True-MAD (atrial displacement of the posterior leaflet in diastole and systole) and Pseudo-MAD (apparent displacement in systole only). The prevalence of True-MAD and Pseudo-MAD in mitral valve prolapse (MVP) is not known. The aim of this study was to assess the prevalence of True-MAD and Pseudo-MAD in myxomatous MVP patients by transthoracic echocardiography (TTE) and to validate TTE compared to cardiac magnetic resonance (CMR; reference standards).

Methods

Consecutive patients who underwent TTE for MVP were included. Mitral annular phenotype was evaluated in the TTE parasternal long-axis view. Accuracy (against CMR) and intra-/interrater reliability of TTE were also assessed.

Results

Six hundred three consecutive patients were included. The prevalence of True-MAD and Pseudo-MAD was 7% (42) and 37% (221) (P < .05), respectively. Accordingly, 221 of 263 (84%) patients classically classified as “MAD” would have been reclassified as Pseudo-MAD. Pseudo-MAD prevalence and systolic length increased with higher mitral regurgitation (MR) severity (23% for mild MR, 36% for moderate MR, 44% for severe MR [P < .05]; 6 ± 2 mm for mild MR; 8 ± 2 mm for moderate MR; 10 ± 2 mm for severe MR [P < .05]), while True-MAD prevalence was consistent across MR grades. Pseudo-MAD was linked to systolic curling and Pickelhaube. Transthoracic echocardiography showed an overall accuracy of 0.89 (Cohen k 0.80), a substantial interrater agreement of 0.87 (k = 0.76), and an almost perfect intrarater agreement of 0.93 (k = 0.85).

Conclusions

True-MAD, unlike Pseudo-MAD, is rare in patients with MVP. Pseudo-MAD is associated with the grade of MR and other echocardiographic features of advanced myxomatous degeneration. Transthoracic echocardiography is an accurate and reliable first-line method to assess mitral annulus morphology in MVP.

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二尖瓣脱垂患者舒张期和收缩期二尖瓣瓣环脱节的发生率。

背景：二尖瓣环脱节（MAD）通常在收缩末期进行评估。然而，仅收缩期的二尖瓣瓣环脱节是非常明显的，目前已发现两种不同的表型：真性 MAD（后叶在舒张期和收缩期发生心房移位）和假性 MAD（仅在收缩期发生明显移位）。真MAD和假MAD在二尖瓣脱垂（MVP）中的发病率尚不清楚。本研究旨在通过经胸超声心动图（TTE）评估真性MAD和假性MAD在肌瘤型MVP患者中的患病率，并与心脏磁共振（CMR）（参考标准）相比验证TTE：方法：纳入因 MVP 而接受 TTE 的连续患者。在 TTE 胸骨旁长轴切面上评估二尖瓣瓣环表型。此外，还评估了 TTE 的准确性（与 CMR 相对照）和评分者内部/评分者之间的可靠性：结果：共纳入 63 名连续患者。结果：共纳入了 633 名连续患者，真性-MAD 和假性-MAD 的发病率分别为 7%（42 人）和 37%（221 人）（p 结论：与假性-MAD 不同，真性-MAD 的发病率较高：真性-MAD与假性-MAD不同，在MVP患者中很少见。假性MAD与MR分级和晚期肌瘤变性的其他超声心动图特征有关。TTE 是评估 MVP 患者二尖瓣环形态的准确可靠的一线方法。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of the American Society of Echocardiography 医学-心血管系统

CiteScore

9.50

自引率

12.30%

发文量

257

审稿时长

66 days

期刊介绍： The Journal of the American Society of Echocardiography(JASE) brings physicians and sonographers peer-reviewed original investigations and state-of-the-art review articles that cover conventional clinical applications of cardiovascular ultrasound, as well as newer techniques with emerging clinical applications. These include three-dimensional echocardiography, strain and strain rate methods for evaluating cardiac mechanics and interventional applications.