Prevalence and prognostic impact of mitral annular disjunction in patients with STEMI - A cardiac magnetic resonance study

J Cardiol. 2022 Nov;80(5):397-401. doi: 10.1016/j.jjcc.2022.06.009. Epub 2022 Jun 29.

Abstract

Background: Mitral annular disjunction (MAD) represents the detachment of the mitral leaflet hinge-point from the ventricular myocardium. Its role in patients with ST-segment-elevation myocardial infarction (STEMI) is unknown. This study aims to investigate the prevalence of MAD by cardiac magnetic resonance imaging (CMR) in STEMI-patients and its association with serious adverse events.

Methods: STEMI-patients (n = 621) underwent CMR 4 days [interquartile range (IQR) 2-5] after percutaneous coronary intervention. Presence and longitudinal extent of MAD were obtained in long-axis cine-images, infarct characteristics in late gadolinium enhancement-images. During a median follow-up time of 366 days (IQR 136-454), patients were observed for the occurrence of major adverse cardiac events (MACE), comprising death, myocardial reinfarction, and congestive heart failure.

Results: Overall, 307 patients (49 %) had MAD. Longitudinal MAD-distance was 4.6 ± 1.7 mm and the P3-segment was affected most frequently (n = 262, 85 % of MAD-patients). MAD-patients had a significantly smaller infarct size, lower prevalence of microvascular obstruction, and intramyocardial hemorrhage as well as a higher ejection fraction (all p < 0.03). During follow-up period, MACE occurred in 52 patients (8 %) and did not show significant difference between patients with and without MAD (7 % vs. 9 %, p = 0.424). Cardiovascular death occurred significantly more often in patients without MAD (n = 10, 3.2 % vs. n = 2, 0.7 %, p = 0.021).

Conclusion: MAD is a rather common finding in patients presenting with STEMI. Patients with MAD had less severe infarct characteristics, however, they were not more commonly affected by MACE. Further confirmation and longer follow-up intervals are necessary to define the exact role of MAD in STEMI patients.

Keywords: Arrhythmic events; Cardiac magnetic resonance imaging; Mitral annular disjunction; Mitral valve; Myocardial infarction.

MeSH terms

  • Contrast Media
  • Gadolinium
  • Humans
  • Magnetic Resonance Imaging / methods
  • Magnetic Resonance Imaging, Cine / methods
  • Magnetic Resonance Spectroscopy
  • Percutaneous Coronary Intervention* / adverse effects
  • Prevalence
  • Prognosis
  • ST Elevation Myocardial Infarction* / diagnostic imaging
  • ST Elevation Myocardial Infarction* / etiology

Substances

  • Contrast Media
  • Gadolinium