Stankowski Kamil, Catapano Federica, Donia Dario, Bragato Renato Maria, Lopes Pedro, Abecasis João, Ferreira António, Slipczuk Leandro, Masci Pier-Giorgio, Condorelli Gianluigi, Francone Marco, Figliozzi Stefano
IRCCS Humanitas Research Hospital, Milano, Italy; Department of Biomedical Sciences, Humanitas University, Milano, Italy.
IRCCS Humanitas Research Hospital, Milano, Italy.
J Cardiovasc Magn Reson. 2025;27(1):101413. doi: 10.1016/j.jocmr.2024.101413. Epub 2024 Dec 30.
Mitral annular disjunction (MAD) is a controversial entity. Recently, a distinction between pseudo-MAD, present in systole and secondary to juxtaposition of the billowing posterior leaflet on the left atrial wall, and true-MAD, where the insertion of the posterior leaflet is displaced on the atrial wall both in diastole or in systole, has been proposed. We investigated the prevalence of pseudo-MAD and true-MAD.
This was a retrospective study, including consecutive patients referred to cardiovascular magnetic resonance (CMR). MAD was defined as a ≥1 mm displacement between the left atrial wall-mitral valve leaflet junction hinge and the top of the left ventricular wall, measured from cine-CMR images in the three long-axis views. Pseudo-MAD and true-MAD were defined as the presence of MAD only in systole or both in systole and diastole, respectively.
Two hundred and ninety patients (59 [47-71] years; 181/290 men, 62%) were included. Mitral valve prolapse (MVP) and MAD were found in 24/290 (8%) and 145/290 (50%) patients, of which 100/290 (35%) with true-MAD and 45/290 (16%) with pseudo-MAD. In all measurements, systolic MAD extent (2.3 [1.7-3.0] mm) resulted equal to or greater than diastolic MAD extent (2.0 [1.5-2.9] mm). The most frequent MAD location was the inferior wall (117/290, 40%) and the inferolateral wall was the rarest (50/290, 17%). In patients with MVP, the prevalence of MAD was higher (21/24, 88%), mainly driven by a higher prevalence of pseudo-MAD, as the prevalence of true-MAD did not vary significantly in patients with vs without MVP (p = 0.22), except for the inferolateral wall (9/24, 38% vs 20/266, 8%; p < 0.001). The extent of pseudo-MAD was greater in patients with MVP (4.0 [3.0-5.6] mm) than in those without MVP (2.0 [1.5-3.0]; p < 0.001), whereas the extent of true-MAD did not differ significantly (2.5 [2.0-3.2] mm and 1.9 [1.5-2.9] mm; p = 0.06). At the inferolateral wall, the prevalence of pseudo-MAD was 7/24, 29% vs 14/266, 5% (p < 0.001) in patients with vs without MVP.
True-MAD was a common imaging finding in patients undergoing CMR, irrespective of MVP. Patients with MVP showed higher prevalence and extent of pseudo-MAD in all locations and true-MAD in the inferolateral wall.
二尖瓣环分离（MAD）是一个存在争议的实体。最近，有人提出将假性MAD（存在于收缩期，继发于后叶膨出与左心房壁并置）与真性MAD（后叶附着点在舒张期或收缩期均在心房壁上移位）区分开来。我们调查了假性MAD和真性MAD的患病率。
这是一项回顾性研究，纳入了连续转诊至心血管磁共振（CMR）检查的患者。MAD定义为左心房壁-二尖瓣叶交界铰链与左心室壁顶部之间的位移≥1mm，通过三个长轴视图的电影CMR图像测量。假性MAD和真性MAD分别定义为仅在收缩期或收缩期和舒张期均存在MAD。
纳入290例患者（年龄59[47-71]岁；181/290为男性，占62%）。24/290（8%）例患者发现二尖瓣脱垂（MVP），145/290（50%）例患者发现MAD，其中100/290（35%）例为真性MAD，45/290（16%）例为假性MAD。在所有测量中，收缩期MAD范围（2.3[1.7-3.0]mm）等于或大于舒张期MAD范围（2.0[1.5-2.9]mm）。最常见的MAD部位是下壁（117/290，40%），最罕见的是下侧壁（50/290，17%）。在MVP患者中，MAD的患病率更高（21/24，88%），主要是由于假性MAD的患病率更高，因为真性MAD在有MVP和无MVP患者中的患病率差异无统计学意义（p=0.22），下侧壁除外（9/24，38%对20/266，8%；p<0.001）。MVP患者的假性MAD范围（4.0[3.0-5.6]mm）大于无MVP患者（2.0[1.5-3.0]；p<0.001），而真性MAD范围差异无统计学意义（分别为2.5[2.0-3.2]mm和1.9[1.5-2.9]mm；p=0.06）。在下侧壁处，有MVP患者的假性MAD患病率为7/24，29%，无MVP患者为14/266，5%（p<0.001）。
真性MAD是接受CMR检查患者的常见影像学表现，与MVP无关。MVP患者在所有部位的假性MAD患病率和范围以及下侧壁的真性MAD患病率和范围均更高。
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