Definition, prevalence, and clinical significance of mitral annular disjunction in different patient cohorts: A systematic review

Abstract

Background: Mitral annular disjunction (MAD) is a structural abnormality involving a distinct separation of the left atrium/mitral valve annulus and myocardium continuum.The literature around MAD has increased over recent years, thus we sought to review the current data on the definition, prevalence, and clinical outcomes of MAD.Methods: A search of MEDLINE and EMBASE was conducted to identify studies which evaluated MAD in any patient cohort. The study results were synthesized narratively.Results: A total of 12 studies were included with 3925 patients (average age 62 years, 63% male). The pooled prevalence of MAD in patients with mitral valve prolapse and/or Barlow's disease was 30.1%. In a general population, MAD prevalence was 8.7%. The definition of MAD was not consistent across all studies. In terms of clinical outcomes, only one study reported MAD to be associated with ventricular arrhythmias. Conclusions:MAD is an increasingly recognized finding amongst patients undergoing cardiac imaging. This review highlights the need for agreed definitions for clinically significant MAD and how identified MAD should be managed. At present, there is insufficient evidence that MAD is associated adverse clinical outcomes.

Mitral annular disjunction identified peripartum: A case highlighting key features of a recently classified syndrome

“…In line with the current literature, this case features a young female with numerous factors that are characteristic of MAD 3–5 . Together with a MAD distance of 8.5 mm by TTE, the associated factors include palpitations, 2 syncope, 3 low ejection fraction (51 ± 5%), 2 chest pain and ventricular arrythmia 6 .…”

“…Importantly, what is clear is that ventricular arrhythmia is associated with MAD, independent of concomitant MVP 2 . With MAD, ventricular arrhythmias and SCD are the most immediate concern, as 10%–12% will experience a life‐threatening cardiac arrhythmic episode in their lifetime 2–4 . In our case, the Holter monitor recorded for a period of 26 h and 47 min, during which time there was no supraventricular ectopy.…”

“…Left is a diagram with red arrows indicating the location of PM MAD. Right is the TTE view of MAD also with red arrows in the location of PM MAD 3 …”

Imaging Considerations and Clinical Implications of Mitral Annular Disjunction

“…In total, available studies suggest that the prevalence of MAD is between 16% and 55% in patients with MVP and/or severe MR. 7,13–16 A recent systematic review of12 studies reported a pooled prevalence of MAD of 30.1% for patients with MVP and/or Barlow’s disease and 8.7% for the general population. 17…”

The Importance of Mitral Valve Prolapse Doming Volume in the Assessment of Left Ventricular Stroke Volume with Cardiac MRI

“…Mitral annular disjunction (MAD) has a strong association with ventricular arrhythmias and sudden cardiac death [ 40 ], with a prevalence of 30.1% in MVP patients [ 41 ], and is independently associated with excess risk for arrhythmic events [ 42 ]. Previous studies have suggested that MVP strongly predicts MAD [ 43 ].…”