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To Each Imaging Modality, Their Own MAD.

Kamil Stankowski1,2, Georgios Georgiopoulos3, Maria Lo Monaco4

  • 1IRCCS Humanitas Research Hospital, Via Alessandro Manzoni, Rozzano, Milano, Italy.

Echocardiography (Mount Kisco, N.Y.)
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Summary

Mitral annular disjunction (MAD) is frequently detected by cardiac magnetic resonance (CMR) but rarely by transthoracic echocardiography (TTE). Increasing the diagnostic threshold improves agreement between these imaging modalities for MAD.

Keywords:
cardiac magnetic resonanceechocardiographymitral annular disjunctionmitral valve prolapsemultimodality imaging

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Area of Science:

  • Cardiology
  • Medical Imaging
  • Echocardiography

Background:

  • Mitral annular disjunction (MAD) is a poorly understood echocardiographic finding.
  • Prevalence of MAD may vary based on the imaging modality used.
  • Clinical significance of MAD remains uncertain.

Purpose of the Study:

  • To assess the prevalence of MAD using transthoracic echocardiography (TTE) and cardiac magnetic resonance (CMR).
  • To evaluate the inter-modality agreement between TTE and CMR for MAD detection.
  • To investigate the impact of diagnostic criteria on MAD prevalence and agreement.

Main Methods:

  • Observational retrospective study including 124 patients who underwent both TTE and CMR within 6 months.
  • MAD defined as systolic separation ≥1 mm between left atrial wall-mitral leaflet and left ventricular wall.
  • Maximum MAD longitudinal extent measured; inter-modality agreement analyzed using Cohen's kappa and ICC.

Main Results:

  • MAD detected in 48% of patients by CMR (n=60) versus 8% by TTE (n=10).
  • Low inter-modality agreement (Cohen's kappa = 0.17) improved significantly when the diagnostic cut-off increased to 5 mm (kappa = 0.66).
  • Median MAD length: 2.0 mm by CMR vs. 4.0 mm by TTE; moderate agreement (ICC = 0.66).

Conclusions:

  • MAD of limited extent is common on CMR, with most cases missed by TTE.
  • Increasing the diagnostic threshold for MAD from 1 mm to 5 mm enhances TTE-CMR agreement.
  • Discrepancies in MAD assessment methods contribute to varied prevalence and clinical significance reports.