Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography · 2024
Prevalence of Diastolic and Systolic Mitral Annular Disjunction in Patients With Mitral Valve Prolapse.
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Fiore Giorgio, Rizza Vincenzo, Ingallina Giacomo, Ancona Francesco, Stella Stefano, Biondi Federico, Cunsolo Paola, Gaspardone Carlo, Romagnolo Davide, Tavernese Annamaria, Belli Martina, Margonato Davide, Palmisano Anna, Esposito Antonio, Maisano Francesco, Faletra Francesco Fulvio, Agricola Eustachio
Аннотация
BACKGROUNDS: Mitral annular disjunction (MAD) is commonly evaluated at end systole. However, a systolic-only disjunction is merely apparent, and 2 distinct phenotypes have been identified: True-MAD (atrial displacement of the posterior leaflet in diastole and systole) and Pseudo-MAD (apparent displacement in systole only). The prevalence of True-MAD and Pseudo-MAD in mitral valve prolapse (MVP) is not known. The aim of this study was to assess the prevalence of True-MAD and Pseudo-MAD in myxomatous MVP patients by transthoracic echocardiography (TTE) and to validate TTE compared to cardiac magnetic resonance (CMR; reference standards).
METHODS: Consecutive patients who underwent TTE for MVP were included. Mitral annular phenotype was evaluated in the TTE parasternal long-axis view. Accuracy (against CMR) and intra-/interrater reliability of TTE were also assessed.
RESULTS: Six hundred three consecutive patients were included. The prevalence of True-MAD and Pseudo-MAD was 7% (42) and 37% (221) (P < .05), respectively. Accordingly, 221 of 263 (84%) patients classically classified as "MAD" would have been reclassified as Pseudo-MAD. Pseudo-MAD prevalence and systolic length increased with higher mitral regurgitation (MR) severity (23% for mild MR, 36% for moderate MR, 44% for severe MR [P < .05]; 6 ± 2 mm for mild MR; 8 ± 2 mm for moderate MR; 10 ± 2 mm for severe MR [P < .05]), while True-MAD prevalence was consistent across MR grades. Pseudo-MAD was linked to systolic curling and Pickelhaube. Transthoracic echocardiography showed an overall accuracy of 0.89 (Cohen k 0.80), a substantial interrater agreement of 0.87 (k = 0.76), and an almost perfect intrarater agreement of 0.93 (k = 0.85).
CONCLUSIONS: True-MAD, unlike Pseudo-MAD, is rare in patients with MVP. Pseudo-MAD is associated with the grade of MR and other echocardiographic features of advanced myxomatous degeneration. Transthoracic echocardiography is an accurate and reliable first-line method to assess mitral annulus morphology in MVP.
METHODS: Consecutive patients who underwent TTE for MVP were included. Mitral annular phenotype was evaluated in the TTE parasternal long-axis view. Accuracy (against CMR) and intra-/interrater reliability of TTE were also assessed.
RESULTS: Six hundred three consecutive patients were included. The prevalence of True-MAD and Pseudo-MAD was 7% (42) and 37% (221) (P < .05), respectively. Accordingly, 221 of 263 (84%) patients classically classified as "MAD" would have been reclassified as Pseudo-MAD. Pseudo-MAD prevalence and systolic length increased with higher mitral regurgitation (MR) severity (23% for mild MR, 36% for moderate MR, 44% for severe MR [P < .05]; 6 ± 2 mm for mild MR; 8 ± 2 mm for moderate MR; 10 ± 2 mm for severe MR [P < .05]), while True-MAD prevalence was consistent across MR grades. Pseudo-MAD was linked to systolic curling and Pickelhaube. Transthoracic echocardiography showed an overall accuracy of 0.89 (Cohen k 0.80), a substantial interrater agreement of 0.87 (k = 0.76), and an almost perfect intrarater agreement of 0.93 (k = 0.85).
CONCLUSIONS: True-MAD, unlike Pseudo-MAD, is rare in patients with MVP. Pseudo-MAD is associated with the grade of MR and other echocardiographic features of advanced myxomatous degeneration. Transthoracic echocardiography is an accurate and reliable first-line method to assess mitral annulus morphology in MVP.