Mitral Annular Disjunction: Epidemiology, Diagnostic Methods, Prognosis, and Novel Implications

Area of Science:

• Cardiology
• Cardiac Imaging
• Electrophysiology

Background:

• Mitral annular disjunction (MAD) is a recognized abnormality of the mitral valve apparatus.
• It is associated with mitral valve prolapse, ventricular arrhythmias, and sudden cardiac death.
• MAD is defined as separation between the mitral annulus and left ventricular myocardium, visualized during systole.

Purpose of the Study:

• To provide a comprehensive overview of Mitral Annular Disjunction (MAD).
• To discuss prevalence, anatomical features, and diagnostic challenges using multiple imaging modalities.
• To explore pathophysiological roles, prognostic implications, and management strategies for MAD.

Main Methods:

• Review of recent large-scale imaging studies.
• Analysis of expert consensus documents.
• Inclusion of newly proposed classifications (e.g., true vs. pseudo-MAD).

Main Results:

• MAD is increasingly recognized with specific anatomical features.
• Diagnostic challenges exist across echocardiography, CMR, and CT.
• Risk stratification and clinical frameworks are proposed.

Conclusions:

• MAD is a potentially arrhythmogenic condition requiring systematic evaluation.
• Understanding MAD's imaging and electrophysiological aspects is crucial.
• A practical clinical framework aids in managing patients with MAD.