Mitral Annular Disjunction Assessed Using CMR Imaging

Zugwitz, Daša; Fung, Kenneth; Aung, Nay; Rauseo, Elisa; McCracken, Celeste; Messaoudi, Saloua El; Anderson, Robert H.; Neubauer, Stefan; Petersen, Steffen E.; Nijveldt, Robin

doi:10.1016/j.jcmg.2022.07.015

Cited by 36 publications

(18 citation statements)

References 27 publications

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“…This is consistent with Zugwitz et al . [ 18 ], who recently proved that disjunction at any location is quite common in the general population (up to 76% of cases), while its infero-lateral occurrence is rare and associated with MVP. We found no difference in MAD prevalence between arrhythmogenic and non-arrhythmogenic patients.…”

Section: Discussionmentioning

confidence: 99%

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The impact of mitral valve surgery on ventricular arrhythmias in patients with Barlow’s disease: preliminary results of a prospective study

Ascione

Guicciardi

Lorusso

et al. 2023

Interdisciplinary CardioVascular and Thoracic Surgery

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Objectives Aim of this study was to evaluate arrhythmic burden of patients with Barlow’s disease and significant mitral regurgitation (MR) and assess the impact of mitral repair on ventricular arrhythmias (VA) in this group of subjects. Methods We prospectively included 88 consecutive patients with Barlow’s disease referred to our Institution from February 2021 to May 2022. All enrolled patients underwent 24-hour Holter monitoring before surgery. Sixty-three of them completed 3 months echocardiographic and Holter follow-up. Significant arrhythmic burden was defined as ≥ 1% premature ventricular beats/24 hours or at least one episode of non-sustained ventricular tachycardia (VT), VT or ventricular fibrillation. Results At baseline, 29 patients (33%) were arrhythmogenic (AR) while 59 (67%) were not (NAR). AR subjects tended to be more often females with history of palpitations. Sixty-three patients completed 3-months follow-up. Twenty of them (31.7%) were AR at baseline and 43 (68.3%) were not. Among AR patients, 9 (45%) remained AR after mitral surgery, while 11 (55%) became NAR. Considering NAR subjects at baseline, after mitral valve repair 8 (18.6%) evolved into AR, while 35 (81.4%) remained NAR. A higher prevalence of pre-operative MAD was found among patients experiencing VA reduction if compared with patients who remained arrhythmogenic (63.6% vs 11.1%, p = 0.028). Conclusions In our experience, 1/3 of Barlow’s patients referred for mitral surgery showed a significant arrhythmic burden. Almost half of the subjects arrhythmogenic at baseline were free from significant VA after mitral repair. However, a minority (18.6%) of subjects without arrhythmic burden at baseline experienced significant VA at follow-up.

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Section: Discussionmentioning

confidence: 99%

“…MAD distance was measured in the parasternal long-axis view at end-systole, from the insertion of the posterior leaflet on the detached mitral annulus to the border of the bulging left ventricle [ 18 , 19 ].…”

Section: Methodsmentioning

confidence: 99%

The impact of mitral valve surgery on ventricular arrhythmias in patients with Barlow’s disease: preliminary results of a prospective study

Ascione

Guicciardi

Lorusso

et al. 2023

Interdisciplinary CardioVascular and Thoracic Surgery

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“…The mechanical stretch of both papillary muscle and of the inferolateral LV wall caused by MAD and/or by mitral prolapse may participate to this systolic hypoperfusion [ 26 – 31 ]. We considered only MAD of the inferolateral wall that was found 5% of the entire population (patients and controls), accordingly with the prevalence found by Zugwitz et al [ 32 ]. However, although the prevalence of MAD and of mitral prolapse was greater in patients with Dark-Paps, 80% of patients with Dark-Paps had neither MAD nor prolapse.…”

Section: Discussionmentioning

confidence: 99%

Dark papillary muscles sign: a novel prognostic marker for cardiac magnetic resonance

et al. 2023

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Objectives The prognostic role of left ventricular (LV) papillary muscle abnormalities in patients with preserved LV systolic ejection fraction (LVEF) is unknown. We sought to evaluate the prognosis role of LV papillary muscle abnormalities by CMR in patients with ventricular arrhythmias, preserved LVEF with no cardiac disease. Methods A total of 391 patients with > 500/24 h premature ventricular complexes and/or with non-sustained ventricular tachycardia (NSVT), preserved LVEF, and no cardiac disease were enrolled. Different features of LV papillary muscles were considered: supernumerary muscles, papillary thickness, the attachment, late gadolinium enhancement (LGE). Dark-Paps was defined as end-systolic signal hypointensity of both papillary muscles in early post-contrast cine CMR images. Mitral valve prolapse, mitral annular disjunction (MAD), and myocardial LGE were considered. Results Dark-Paps was found in 79 (20%) patients and was more frequent in females. It was associated with higher prevalence of mitral valve prolapse and MAD. During a median follow-up of 2534 days, 22 hard cardiac events occurred. At Kaplan-Meier curve analysis, patients with Dark-Paps were at higher risk of events than those without (p < 0.0001). Dark-Paps was significantly associated with hard cardiac events in all the multivariate models. Dark-Paps improved prognostic estimation when added to NSVT (p = 0.0006), to LGE (p = 0.005) and to a model including NSVT+LGE (p = 0.014). Dark-Paps allowed a significant net reclassification when added to NSVT (NRI 0.30, p = 0.03), to LGE (NRI 0.25, p = 0.04), and to NSVT + LGE (NRI 0.32, p = 0.02). Conclusions In LV papillary muscles, Dark-Paps is a novel prognostic marker in patients with ventricular arrhythmias and preserved ejection fraction. Key Points • Papillary muscle abnormalities are seen in patients with ventricular arrhythmias and preserved left ventricular ejection fraction. • Early post-contrast hypointensity of papillary muscles in end-systolic cine images (Dark-Paps) is a novel prognostic marker in patients with ventricular arrhythmias and preserved ejection fraction. • Dark-Paps had an additive prognostic role over late gadolinium enhancement and non-sustained ventricular tachycardia.

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“…The heart is a complex multiscale muscular pump with interconnected components at both micro-and macro scales which need to work together as one functionally unit and which change during evolution of CVDs. Despite decades of anatomic description, important research questions remain including identifying the anatomic substrates for cardiac arrhythmia, mitral annular disjunction (3,4), atrial and ventricular mural architecture (5), as well as the changes that occur throughout life in the increasing number of patients living with congenital heart disease.…”

Section: Introductionmentioning

confidence: 99%

Multidimensional Analysis of the Adult Human Heart in Health and Disease using Hierarchical Phase-Contrast Tomography (HiP-CT)

Brunet,

Cook,

Walsh

et al. 2023

Preprint

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Cardiovascular diseases (CVDs) are a leading cause of death worldwide. Current clinical imaging modalities provide resolution adequate for diagnosis but are unable to provide detail of structural changes in the heart, across length-scales, necessary for understanding underlying pathophysiology of disease. Hierarchical Phase-Contrast Tomography (HiP-CT), using new (4th) generation synchrotron sources, potentially overcomes this limitation, allowing micron resolution imaging of intact adult organs with unprecedented detail. In this proof of principle study (n=2), we show the utility of HiP-CT to image whole adult human hearts ex-vivo: one ‘control’ without known cardiac disease and one with multiple known cardiopulmonary pathologies. The resulting multiscale imaging was able to demonstrate exemplars of anatomy in each cardiac segment along with novel findings in the cardiac conduction system, from gross (20 um/voxel) to cellular scale (2.2 um/voxel), non-destructively, thereby bridging the gap between macroscopic and microscopic investigations. We propose that the technique represents a significant step in virtual autopsy methods for studying structural heart disease, facilitating research into abnormalities across scales and age-groups. It opens up possibilities for understanding and treating disease; and provides a cardiac ‘blueprint’ with potential for in-silico simulation, device design, virtual surgical training, and bioengineered heart in the future.

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Mitral Annular Disjunction Assessed Using CMR Imaging

Cited by 36 publications

References 27 publications

The impact of mitral valve surgery on ventricular arrhythmias in patients with Barlow’s disease: preliminary results of a prospective study

The impact of mitral valve surgery on ventricular arrhythmias in patients with Barlow’s disease: preliminary results of a prospective study

Dark papillary muscles sign: a novel prognostic marker for cardiac magnetic resonance

Multidimensional Analysis of the Adult Human Heart in Health and Disease using Hierarchical Phase-Contrast Tomography (HiP-CT)

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