True- and pseudo-mitral annular disjunction in patients undergoing cardiovascular magnetic resonance
ABSTRACT: Background: Mitral annular disjunction (MAD) is a controversial entity. Recently, a distinction between pseudo-MAD, present in systole and secondary to juxtaposition of the billowing posterior leaflet on the left atrial wall, and true-MAD, where the insertion of the posterior leaflet is d...
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Elsevier
2025-01-01
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| Series: | Journal of Cardiovascular Magnetic Resonance |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S1097664724014406 |
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| author | Kamil Stankowski Federica Catapano Dario Donia Renato Maria Bragato Pedro Lopes João Abecasis António Ferreira Leandro Slipczuk Pier-Giorgio Masci Gianluigi Condorelli Marco Francone Stefano Figliozzi |
| author_facet | Kamil Stankowski Federica Catapano Dario Donia Renato Maria Bragato Pedro Lopes João Abecasis António Ferreira Leandro Slipczuk Pier-Giorgio Masci Gianluigi Condorelli Marco Francone Stefano Figliozzi |
| author_sort | Kamil Stankowski |
| collection | DOAJ |
| description | ABSTRACT: Background: Mitral annular disjunction (MAD) is a controversial entity. Recently, a distinction between pseudo-MAD, present in systole and secondary to juxtaposition of the billowing posterior leaflet on the left atrial wall, and true-MAD, where the insertion of the posterior leaflet is displaced on the atrial wall both in diastole or in systole, has been proposed. We investigated the prevalence of pseudo-MAD and true-MAD. Methods: This was a retrospective study, including consecutive patients referred to cardiovascular magnetic resonance (CMR). MAD was defined as a ≥1 mm displacement between the left atrial wall-mitral valve leaflet junction hinge and the top of the left ventricular wall, measured from cine-CMR images in the three long-axis views. Pseudo-MAD and true-MAD were defined as the presence of MAD only in systole or both in systole and diastole, respectively. Results: Two hundred and ninety patients (59 [47–71] years; 181/290 men, 62%) were included. Mitral valve prolapse (MVP) and MAD were found in 24/290 (8%) and 145/290 (50%) patients, of which 100/290 (35%) with true-MAD and 45/290 (16%) with pseudo-MAD. In all measurements, systolic MAD extent (2.3 [1.7–3.0] mm) resulted equal to or greater than diastolic MAD extent (2.0 [1.5–2.9] mm). The most frequent MAD location was the inferior wall (117/290, 40%) and the inferolateral wall was the rarest (50/290, 17%). In patients with MVP, the prevalence of MAD was higher (21/24, 88%), mainly driven by a higher prevalence of pseudo-MAD, as the prevalence of true-MAD did not vary significantly in patients with vs without MVP (p = 0.22), except for the inferolateral wall (9/24, 38% vs 20/266, 8%; p < 0.001). The extent of pseudo-MAD was greater in patients with MVP (4.0 [3.0–5.6] mm) than in those without MVP (2.0 [1.5–3.0]; p < 0.001), whereas the extent of true-MAD did not differ significantly (2.5 [2.0–3.2] mm and 1.9 [1.5–2.9] mm; p = 0.06). At the inferolateral wall, the prevalence of pseudo-MAD was 7/24, 29% vs 14/266, 5% (p < 0.001) in patients with vs without MVP. Conclusion: True-MAD was a common imaging finding in patients undergoing CMR, irrespective of MVP. Patients with MVP showed higher prevalence and extent of pseudo-MAD in all locations and true-MAD in the inferolateral wall |
| format | Article |
| id | doaj-art-3dffda46917e4bd9ae963f0dabd42957 |
| institution | Kabale University |
| issn | 1097-6647 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of Cardiovascular Magnetic Resonance |
| spelling | doaj-art-3dffda46917e4bd9ae963f0dabd429572025-08-20T03:45:59ZengElsevierJournal of Cardiovascular Magnetic Resonance1097-66472025-01-0127110141310.1016/j.jocmr.2024.101413True- and pseudo-mitral annular disjunction in patients undergoing cardiovascular magnetic resonanceKamil Stankowski0Federica Catapano1Dario Donia2Renato Maria Bragato3Pedro Lopes4João Abecasis5António Ferreira6Leandro Slipczuk7Pier-Giorgio Masci8Gianluigi Condorelli9Marco Francone10Stefano Figliozzi11IRCCS Humanitas Research Hospital, Milano, Italy; Department of Biomedical Sciences, Humanitas University, Milano, ItalyIRCCS Humanitas Research Hospital, Milano, Italy; Department of Biomedical Sciences, Humanitas University, Milano, ItalyIRCCS Humanitas Research Hospital, Milano, Italy; Department of Biomedical Sciences, Humanitas University, Milano, ItalyIRCCS Humanitas Research Hospital, Milano, ItalyCardiology Department, Hospital de Santa Cruz, Lisboa, PortugalCardiology Department, Hospital de Santa Cruz, Lisboa, PortugalCardiology Department, Hospital de Santa Cruz, Lisboa, PortugalMontefiore Health System, Cardiology Division, Bronx, New York, USASchool of Biomedical Engineering and Imaging Sciences, King's College London, London, United KingdomIRCCS Humanitas Research Hospital, Milano, Italy; Department of Biomedical Sciences, Humanitas University, Milano, ItalyIRCCS Humanitas Research Hospital, Milano, Italy; Department of Biomedical Sciences, Humanitas University, Milano, ItalyIRCCS Humanitas Research Hospital, Milano, Italy; Department of Biomedical Sciences, Humanitas University, Milano, Italy; Corresponding author.ABSTRACT: Background: Mitral annular disjunction (MAD) is a controversial entity. Recently, a distinction between pseudo-MAD, present in systole and secondary to juxtaposition of the billowing posterior leaflet on the left atrial wall, and true-MAD, where the insertion of the posterior leaflet is displaced on the atrial wall both in diastole or in systole, has been proposed. We investigated the prevalence of pseudo-MAD and true-MAD. Methods: This was a retrospective study, including consecutive patients referred to cardiovascular magnetic resonance (CMR). MAD was defined as a ≥1 mm displacement between the left atrial wall-mitral valve leaflet junction hinge and the top of the left ventricular wall, measured from cine-CMR images in the three long-axis views. Pseudo-MAD and true-MAD were defined as the presence of MAD only in systole or both in systole and diastole, respectively. Results: Two hundred and ninety patients (59 [47–71] years; 181/290 men, 62%) were included. Mitral valve prolapse (MVP) and MAD were found in 24/290 (8%) and 145/290 (50%) patients, of which 100/290 (35%) with true-MAD and 45/290 (16%) with pseudo-MAD. In all measurements, systolic MAD extent (2.3 [1.7–3.0] mm) resulted equal to or greater than diastolic MAD extent (2.0 [1.5–2.9] mm). The most frequent MAD location was the inferior wall (117/290, 40%) and the inferolateral wall was the rarest (50/290, 17%). In patients with MVP, the prevalence of MAD was higher (21/24, 88%), mainly driven by a higher prevalence of pseudo-MAD, as the prevalence of true-MAD did not vary significantly in patients with vs without MVP (p = 0.22), except for the inferolateral wall (9/24, 38% vs 20/266, 8%; p < 0.001). The extent of pseudo-MAD was greater in patients with MVP (4.0 [3.0–5.6] mm) than in those without MVP (2.0 [1.5–3.0]; p < 0.001), whereas the extent of true-MAD did not differ significantly (2.5 [2.0–3.2] mm and 1.9 [1.5–2.9] mm; p = 0.06). At the inferolateral wall, the prevalence of pseudo-MAD was 7/24, 29% vs 14/266, 5% (p < 0.001) in patients with vs without MVP. Conclusion: True-MAD was a common imaging finding in patients undergoing CMR, irrespective of MVP. Patients with MVP showed higher prevalence and extent of pseudo-MAD in all locations and true-MAD in the inferolateral wallhttp://www.sciencedirect.com/science/article/pii/S1097664724014406Mitral valve prolapsePseudo-MADTrue-MADSpatial resolutionCMRMultimodality imaging |
| spellingShingle | Kamil Stankowski Federica Catapano Dario Donia Renato Maria Bragato Pedro Lopes João Abecasis António Ferreira Leandro Slipczuk Pier-Giorgio Masci Gianluigi Condorelli Marco Francone Stefano Figliozzi True- and pseudo-mitral annular disjunction in patients undergoing cardiovascular magnetic resonance Journal of Cardiovascular Magnetic Resonance Mitral valve prolapse Pseudo-MAD True-MAD Spatial resolution CMR Multimodality imaging |
| title | True- and pseudo-mitral annular disjunction in patients undergoing cardiovascular magnetic resonance |
| title_full | True- and pseudo-mitral annular disjunction in patients undergoing cardiovascular magnetic resonance |
| title_fullStr | True- and pseudo-mitral annular disjunction in patients undergoing cardiovascular magnetic resonance |
| title_full_unstemmed | True- and pseudo-mitral annular disjunction in patients undergoing cardiovascular magnetic resonance |
| title_short | True- and pseudo-mitral annular disjunction in patients undergoing cardiovascular magnetic resonance |
| title_sort | true and pseudo mitral annular disjunction in patients undergoing cardiovascular magnetic resonance |
| topic | Mitral valve prolapse Pseudo-MAD True-MAD Spatial resolution CMR Multimodality imaging |
| url | http://www.sciencedirect.com/science/article/pii/S1097664724014406 |
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