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Mitral Annular Disjunction Assessed Using CMR Imaging: Insights From the UK Biobank Population Study

Dasa Zugwitz1, Kenneth Fung2, Nay Aung2

  • 1Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia; Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands; William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, London, United Kingdom.

JACC. Cardiovascular Imaging
|October 24, 2022
PubMed

Insights

Mitral annular disjunction is common, found in 76% of participants. Clinically significant inferolateral disjunction, however, is rare, suggesting it may be a normal variant unless extensive.

Area of Science:

  • Cardiology
  • Cardiac Imaging
  • Electrophysiology

Background:

  • Mitral annular disjunction (MAD) involves atrial displacement of the mitral valve leaflet hinge point.
  • MAD is potentially linked to malignant ventricular arrhythmias and sudden cardiac death.
  • The prevalence of MAD in the general population remains largely unknown.

Purpose of the Study:

  • To determine the frequency and extent of mitral annular disjunction in a large population.
  • To investigate the association between MAD and specific cardiac abnormalities.

Main Methods:

  • Cardiac magnetic resonance (CMR) imaging was used to assess 2,646 Caucasian subjects from the UK Biobank.
  • Measurements included disjunction length at four annular points, leaflet prolapse/billowing, and inferolateral wall motion.
  • 2,607 participants were included in the final analysis.

Main Results:

  • Mitral annular disjunction was detected in 1,990 (76%) participants, predominantly at the anterior and inferior walls.
  • Clinically significant inferolateral disjunction occurred in only 5% (134) of cases.
  • Disjunction was associated with increased odds of prolapse (OR 2.5) and systolic curling (OR 3.6).

Conclusions:

  • CMR imaging reveals mitral annular disjunction to be a common finding.
  • Inferolateral disjunction is rare, and its association with prolapse and curling suggests it may be clinically significant.
  • Disjunction at other sites is common and likely a normal variant, with extensive inferolateral disjunction warranting further investigation.
Abstract

Keywords:
cardiac magnetic resonancemitral annular disjunctionmitral valve prolapse

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