Mitral annular disjunction in patients with severe aortic stenosis: Extent and reproducibility of measurements with computed tomography

Tsianaka, T.; Matziris, Ioannis; Kobe, Adrian; Euler, André; Kuzo, Nazar; Erhart, Ladina; Leschka, Sebastian; Manka, Robert; Kasel, Albert Markus; Tanner, Felix C.; Alkadhi, Hatem; Eberhard, Matthias

doi:10.1016/j.ejro.2021.100335

Cited by 10 publications

(17 citation statements)

References 35 publications

(20 reference statements)

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“…15 Another study of patients with severe aortic stenosis found MAD, in comparison to no MAD, was not associated with atrial flutter or fibrillation (34% vs 21%, p = 0.12, bundle branch block conduction (13% vs 26%, p = 0.13), atrioventricular block (19% vs 17%, p = 0.81) or permanent pacemaker implantation (0% vs 6%, p = 0.39) pre TAVI. 18 In one study, there was an association between the presence of ventricular arrhythmias (including symptomatic and frequent pre- 17 Here, CMR was able to detect MAD of smaller distances more frequently than TTE and TOE. 17 This review highlights that there is no consistent definition for clinically relevant MAD.…”

Section: Mad and Arrhythmic Eventsmentioning

confidence: 99%

“…Our search yielded 80 potentially relevant studies. After screening of titles, abstracts, and full manuscripts of potentially relevant studies, a total of twelve studies 1,8,[11][12][13][14][15][16][17][18][19][20] met the inclusion criteria and were included in the review (Figure 4). 1.…”

Section: Study Selection and Description Of Included Studiesmentioning

confidence: 99%

“…Ascertainment of MAD was deemed to be reliable in four studies. 8,[16][17][18] Eriksson et al 1 was the only study to include the assessment of outcomes during a specified follow up time period. Here, clinical outcomes included all-cause mortality and freedom from re-do MV surgery.…”

Section: Study Quality Assessmentmentioning

confidence: 99%

“…8 In patients with severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI), Tsianaka et al reported that 92% had MAD. 18…”

Section: Mad In Other Patient Cohortsmentioning

confidence: 99%

“…Only three studies commented on arrhythmic events in patients with MAD. 15,18,19 Konda et al found that arrhythmic events and sudden cardiac death occurred in 7/185 (3.8%) of the population and none had MAD. 15 Another study of patients with severe aortic stenosis found MAD, in comparison to no MAD, was not associated with atrial flutter or fibrillation (34% vs 21%, p = 0.12, bundle branch block conduction (13% vs 26%, p = 0.13), atrioventricular block (19% vs 17%, p = 0.81) or permanent pacemaker implantation (0% vs 6%, p = 0.39) pre TAVI.…”

Section: Mad and Arrhythmic Eventsmentioning

confidence: 99%

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

et al. 2022

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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.

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Section: Mad and Arrhythmic Eventsmentioning

confidence: 99%

Section: Study Selection and Description Of Included Studiesmentioning

confidence: 99%

Section: Study Quality Assessmentmentioning

confidence: 99%

“…8 In patients with severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI), Tsianaka et al reported that 92% had MAD. 18…”

Section: Mad In Other Patient Cohortsmentioning

confidence: 99%

Section: Mad and Arrhythmic Eventsmentioning

confidence: 99%

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

et al. 2022

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Imaging for the assessment of the arrhythmogenic potential of mitral valve prolapse

Esposito,

Gatti,

Trivieri

et al. 2023

Eur Radiol

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Mitral Annular Disjunction: A Scoping Review

Gupta¹,

Shihabi

Patil

et al. 2023

Cardiology in Review

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Mitral annular disjunction (MAD) is the atrial displacement of the mitral valve (MV) hinge point, especially along the posterior mitral leaflet, which leads to inhomogeneous blood flow into the left ventricle, causing chronic fibrotic changes, malignant arrhythmias, and even sudden cardiac arrest. Some studies suggest that MAD is a part of normal heart morphology; however, the origin is still controversial. MAD commonly occurs with MV prolapse and myxomatous degenerative MV disease. In almost 20% of cases, MAD can occur independently as well. The prevalence of MAD in normal hearts varies from 8.6% to 96%, depending on the imaging modality and the cutoff used to define MAD. Transthoracic echocardiography is often the initial screening test, but the low sensitivity of transthoracic echocardiography to identify MAD makes it easy to miss the diagnosis altogether. More advanced imaging, especially cardiac MRI, is the gold standard for diagnosing MAD and risk stratification. MAD is an independent predictor of malignant arrhythmia. Among patients with MAD, risk stratification is based on the age at diagnosis, previous syncopal attacks, premature ventricular contractions, papillary muscle fibrosis, and longitudinal disjunction distance. Most asymptomatic patients are managed conservatively; however, radiofrequency ablation should be considered in patients with high-risk or symptomatic MAD due to the risk of ventricular arrhythmias and sudden cardiac death.

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Mitral annular disjunction in patients with severe aortic stenosis: Extent and reproducibility of measurements with computed tomography

Abstract: Highlights Mitral annulus disjunction (MAD) is frequent in patients with severe aortic stenosis. Computed tomography enables a highly reproducible assessment of MAD. MAD patients significantly more often have mitral valve prolapse.

Cited by 10 publications

References 35 publications

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

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

Imaging for the assessment of the arrhythmogenic potential of mitral valve prolapse

Mitral Annular Disjunction: A Scoping Review

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