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Evaluation of myocardial structural changes in patients with mitral annular disjunction using magnetic resonance imaging

Authors: Aleksandrova S.A., Glazkova E.Yu., Zolotaykina O.S., Berdibekov B.Sh., Dorofeev A.V., Aslanidis I.P.

Company: Bakoulev National Medical Research Center for Cardiovascular Surgery, Moscow, Russian Federation

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Type:  Original articles


DOI: https://doi.org/10.24022/1997-3187-2023-17-3-386-401

For citation: Aleksandrova S.A., Glazkova E.Yu., Zolotaykina O.C., Berdibekov B.Sh., Dorofeev A.V., Aslanidis I.P., Golukhova E.Z. Assessment of structural left heart abnormalities in mitral annular disjunction patients by magnetic resonance imaging. Creative Cardiology. 2023; 17 (3): 386–401 (in Russ.). DOI: 10.24022/1997-3187-2023-17-3-386-401

Received / Accepted:  23.08.2023 / 12.09.2023

Keywords: disjunction mitral annular disjunction arrhythmic mitral valve prolapse magnetic resonance imaging ventricular arrhythmias

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Abstract

Objective. Mitral annular disjunction (MAD) is characterized by shifting place of attachment of the posterior leaflet to the left atrium, which manifests in systole as a “separation” of the annulus fibrosus from the basal sections of the left heart (LV). Structural abnormality is often found in patients with mitral valve prolapse (MVP) and may increase the risk of ventricular arrhythmias and sudden cardiac death. Objective – evaluate a complex of changes in the left heart in patients with mitral annular disjunction (MAD) and mitral valve prolapse (MVP) by magnetic resonance imaging (MRI).

Material and methods. A retrospective analysis of cardiac MRI database in patients with cardiac arrhythmias and MVP formed two groups: 24 patients with MAD and MVP (23 women; mean age 34 years) and 29 MVP patients (15 women; 36 years).

Results. The median separation was 7.5 mm (4–10), the length of separation was 4 mm (3-4). A correlation was revealed between the disjunction and the twisting annulus fibrosis (R=0.917, p<0.000), annulus size (R=0.58, p<0.000), magnitude of the anterior and posterior valves prolapse (R=0.586, p<0.000 and R=0.79, p<0.000, respectively), the volume of fibrous (R=0.548, p<0.000). MAD patients are more likely to have bilateral prolapse and posterior flap prolapse (75 vs. 7%; p<0.000 and 75% vs. 17%, p<0.000). They are also have a high prevalence of LV wall dyskinesis at the level of attachment of papillary muscles (96 vs. 35%), GRSmed (36,8 vs. 25%) and fibrous changes in papillary muscles (82% vs. 21%); (all p<0.000).

Conclusion. Mitral annulus disjunction may be part of arrhythmic mitral valve prolapse phenotype and is associated with left heart structural changes and LV remodeling. MRI allows to identify MAD and evaluate it in complex of mitral valve and LV changes, providing accurate diagnostic and prognostic information for risk stratification of life-threatening conditions.

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About Authors

  • Svetlana A. Aleksandrova, Cand. Med. Sci., Senior Researcher; ORCID
  • Elena Yu. Glazkova, Cand. Med. Sci., Senior Researcher; ORCID
  • Olga S. Zolotaykina, Cand. Med. Sci., Radiologist;
  • Bektur Sh. Berdibekov, Junior Researcher, Cardiologist; ORCID
  • Aleksey V. Dorofeev, Cand. Med. Sci., Head of Department; ORCID
  • Irakliy P. Aslanidis, Dr. Med. Sci., Professor, Deputy Director, Head of Department; ORCID

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery


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