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Prevalence of Mitral Annular Disjunction at Cardiac MRI: Results from a Multicenter Registry
Anna Palmisano1, Elisa Bruno1, Giovanni Donato Aquaro1
1From the Department of Radiology, School of Medicine, Vita-Salute San Raffaele University, Via Olgettina 58-60, 20132 Milan, Italy (A. Palmisano, E.B., S.B., D.V., A.E.); Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Milan, Italy (A. Palmisano, E.B., M.C., D.V., A.E.); Academic Radiology Department of Translational Research, University of Pisa, Pisa, Italy (G.D.A., C.D.G., M.A., D.P., L.F., E.N.); Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Department of Radiodiagnostics, Università di Brescia-Spedali Civili, Brescia, Italy (P.R., N.d.M., M.R., D.F.); Department of Emergency Radiology, University Hospital Careggi, Florence, Italy (A.R., S.P., V.M.); Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Rome, Italy (L.M., G.C., N.G.); Department of Surgical Sciences, University of Turin, Turin, Italy (D.T., M.G., R.F.); Department of Diagnostic Imaging, Area of Cardiovascular and Interventional Imaging, Abruzzo Health Unit 1, L'Aquila, Italy (P.P.); Department of Biotechnological and Applied Clinical Science, University of L'Aquila, L'Aquila, Italy (E.D.C.); Diagnostic and Interventional Radiology Unit, BIOMORF Department, University Hospital Policlinico, Messina, Italy (T.D., L.R.M.L., A.B.); Department of Radiology, Santa Maria delle Grazie Hospital, Pozzuoli, Italy (S.D.); Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy (A. Ponsiglione, R.A., M.I.); Department of Radiology, AOU Cagliari, University of Cagliari, Cagliari, Italy (M.P., R.C., L.S.); Department of Radiology, Ospedale del Mare-ASL NA1 Centro, Naples, Italy (G.F., C.L.); Department of Radiology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy (V.S., S.S.); Department of Radiology, Ospedale Maggiore della Carità University Hospital, Novara, Italy (A.S., A.C.); and IRCCS Azienda Ospedaliero-Universitaria di Bologna, S. Orsola Hospital, University of Bologna, Italy (L.L.).
Abstract:
Purpose To determine the prevalence of mitral annular disjunction (MAD) in patients undergoing cardiac MRI for various clinical indications and to assess the association of MAD with arrhythmia, mitral valve prolapse (MVP), and myocardial alteration. Materials and Methods This study analyzed data from a retrospective observational registry of consecutive patients undergoing cardiac MRI for different clinical indications. Cardiac MRI examinations were performed from January 2019 to June 2019 at 13 Italian hospitals. Images underwent double reading by expert cardiac radiologists from the enrolling center and the core laboratory to assess the presence of MAD. Presence and maximum length of MAD and its association to MVP pattern, functional and structural myocardial alteration, and arrhythmia were evaluated using nonparametric and parametric tests. Logistic regression models were used to identify predictors of arrhythmia. Results Cardiac MRI studies from 2611 consecutive patients (1730, 66% male; median age, 53 years; IQR, 39-65 years) were evaluated. Prevalence of MAD was 5.44% (142 of 2611). MAD was an incidental finding in 74.6% (106 of 142) of patients. Patients with MAD had a higher prevalence of arrhythmias compared with patients without MAD (40% [57 of 142] vs 18% [444 of 2469]; P < .001). Patients with MAD and bileaflet MVP showed a longer MAD compared with patients with single-leaflet or absent MVP (median, 7 mm [IQR, 3-9.5 mm] vs 4 mm [IQR, 3-5 mm]; P < .001), a higher prevalence of systolic curling (75% [21 of 28] vs 30.7% [35 of 114]; P < .001), higher extracellular volume values (30% [IQR, 28%-32%] vs 27% [IQR, 25%-30%]; P = .04), and a higher prevalence of arrhythmia (64.2% [18 of 28] vs 34.2% [39 of 114]; P = .006). MAD length of at least 5 mm was an independent predictor of arrhythmia (odds ratio 3.96; 95% CI: 1.93, 8.15; P < .001). Conclusion MAD was a frequent incidental finding on cardiac MRI scans from a multicenter registry. MAD length of at least 5 mm and coexisting bileaflet MVP showed a higher risk of arrhythmia. Keywords: MR Imaging, Cardiac, Mitral Annular Disjunction Supplemental material is available for this article. ©RSNA, 2024.
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