Prevalence of mitral annular disjunction in patients with mitral valve prolapse and severe regurgitation

Putnam, Andrew J.; Kebed, Kalie; Mor‐Avi, Victor; Rashedi, Nina; Sun, Deyu; Patel, Brooke; Balkhy, Husam H.; Lang, Roberto M.; Patel, Amit R.

doi:10.1007/s10554-020-01818-4

Cited by 40 publications

(26 citation statements)

References 18 publications

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“…On the other hand, the presence of MAD has been mostly associated to severe MR, redundant floppy mitral valve and increased risk of MACE and complex ventricular arrhythmias. [ 44 45 ]…”

Section: Discussionmentioning

confidence: 99%

Impact of Chest Wall Conformation on the Outcome of Primary Mitral Regurgitation due to Mitral Valve Prolapse

Sonaglioni

Nicolosi²,

Rigamonti

et al. 2022

Journal of Cardiovascular Echography

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Background: The possible influence of chest wall conformation on cardiovascular (CV) outcome of patients with mitral regurgitation (MR) due to mitral valve prolapse (MVP) has never been previously investigated. Methods: This retrospective study included all consecutive symptomatic patients with MVP and moderate MR who underwent exercise stress echocardiography at our institution between February 2014 and February 2021. Modified Haller Index (MHI; chest transverse diameter over the distance between sternum and spine) was noninvasively assessed. During the follow-up, we evaluated the occurrence of any of the following: (1) CV hospitalization, (2) mitral valve (MV) surgery, and (3) cardiac death or sudden death. Results: Four hundred and twenty-four consecutive patients (66.8 ± 11.5 years, 48.3% men) were retrospectively analyzed. Overall, MVP patients had concave-shaped chest wall (MHI = 2.55 ± 0.34) and were found with small cardiac chamber dimensions. During a mean follow-up time of 3.2 ± 1.7 years, no patients died, 55 patients were hospitalized due to CV events, and 20 patients underwent MV surgery. On multivariate Cox analysis, age (heart rate [HR] 1.05, 95% confidence interval [CI] 1.03–1.06), diabetes mellitus (HR 3.26, 95% CI 2.04–5.20), peak exercise-E/e' ratio (HR 1.07, 95%CI 1.05–1.09), and peak exercise-effective regurgitant orifice area (HR 2.53, 95% CI 1.83–3.51) were directly associated to outcome, whereas MHI (HR 0.15, 95%CI 0.07-0.33) and beta-blocker therapy (HR 0.26, 95% CI 0.19–0.36) showed strong inverse correlation. An MHI ≥2.7 showed 80% sensitivity and 100% specificity for predicting event-free survival (area under the curve = 0.98). Conclusions: Symptomatic patients with moderate MR due to MVP and MHI ≥2.7 have an excellent prognosis over a medium-term follow-up. Noninvasive chest wall shape assessment should be encouraged in clinical practice.

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“…On the other hand, the presence of MAD has been mostly associated to severe MR, redundant floppy mitral valve and increased risk of MACE and complex ventricular arrhythmias. [ 44 45 ]…”

Section: Discussionmentioning

confidence: 99%

Impact of Chest Wall Conformation on the Outcome of Primary Mitral Regurgitation due to Mitral Valve Prolapse

Sonaglioni

Nicolosi²,

Rigamonti

et al. 2022

Journal of Cardiovascular Echography

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“…Pathological studies have confirmed the absence of associated elastic fibers in the mitral valve of FED-related MVP patients. Second, the myxomarelated MVP (Barlow's disease) subtype is characterized by lengthy thickening of both the anterior and posterior leaflets of the mitral valve, and it is accompanied by mitral annulus disjunction (MAD) (Putnam et al 2020). Pathological performance suggests excessive proliferation and activation of valvular interstitial cells and increased content of type III collagen.…”

Section: Mitral Valve Prolapse (Mvp)mentioning

confidence: 99%

Phenotypes of Cardiovascular Diseases: Current Status and Future Perspectives

2021

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Cardiovascular diseases (CVDs) are a large group of diseases and have become the leading cause of morbidity and mortality worldwide. Although considerable progresses have been made in the diagnosis, treatment and prognosis of CVD, communication barriers between clinicians and researchers still exist because the phenotypes of CVD are complex and diverse in clinical practice and lack of unity. Therefore, it is particularly important to establish a standardized and unified terminology to describe CVD. In recent years, there have been several studies, such as the Human Phenotype Ontology, attempting to provide a standardized description of the disease phenotypes. In the present article, we outline recent advances in the classification of the major types of CVD to retrospectively review the current progresses of phenotypic studies in the cardiovascular field and provide a reference for future cardiovascular research.

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“…The displacement distance can be measured non-invasively by echocardiography, cardiac computed tomography (CT), and cardiac magnetic resonance (CMR). In subsequent studies of various cohorts of MVP, MAD has been identified in approximately 15-55% of patients with significant variation based on the different cohorts studied and imaging modalities utilized [19][20][21][22][23][24][25][26][27]. A systematic review found MAD in about 33% of MVP patients [19].…”

Section: Introductionmentioning

confidence: 99%

Arrhythmic Mitral Valve Prolapse and Mitral Annular Disjunction: Clinical Features, Pathophysiology, Risk Stratification, and Management

Chakrabarti

Bogun

Liang

2022

JCDD

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Mitral valve prolapse (MVP) is a common cause of valvular heart disease. Although many patients with MVP have a benign course, there is increasing recognition of an arrhythmic phenotype associated with ventricular arrhythmias and sudden cardiac death (SCD). Pathophysiologic mechanisms associated with arrhythmias include cardiac fibrosis, mechanical stress induced changes in ventricular refractory periods, as well as electrophysiologic changes in Purkinje fibers. Clinically, a variety of risk factors including demographic, electrocardiographic, and imaging characteristics help to identify patients with MVP at the highest at risk of SCD and arrhythmias. Once identified, recent advances in treatment including device therapy, catheter ablation, and surgical interventions show promising outcomes. In this review, we will summarize the incidence of ventricular arrhythmias and SCD in patients with MVP, the association with mitral annular disjunction, mechanisms of arrhythmogenesis, methods for arrhythmic and SCD risk stratification including findings with multimodality imaging, and treatments for the primary and secondary prevention of SCD.

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Prevalence of mitral annular disjunction in patients with mitral valve prolapse and severe regurgitation

Cited by 40 publications

References 18 publications

Impact of Chest Wall Conformation on the Outcome of Primary Mitral Regurgitation due to Mitral Valve Prolapse

Impact of Chest Wall Conformation on the Outcome of Primary Mitral Regurgitation due to Mitral Valve Prolapse

Phenotypes of Cardiovascular Diseases: Current Status and Future Perspectives

Arrhythmic Mitral Valve Prolapse and Mitral Annular Disjunction: Clinical Features, Pathophysiology, Risk Stratification, and Management

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