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Evaluation of Left Ventricular Function in Patients with Mitral Annular Disjunction Using Speckle Tracking Echocardiography
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  • Omer Dogan,
  • Serhan Ozyildirim,
  • Baris Guven,
  • Mehmet Tugay Yumuk,
  • Hasan Barman,
  • Cagdas Topel,
  • Adem Atıcı,
  • Ayça Donmez,
  • Serdar Kucukoglu,
  • sait m. dogan
Omer Dogan
Istinye State Hospital

Corresponding Author:[email protected]

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Serhan Ozyildirim
Istanbul University-Cerrahpaşa
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Baris Guven
Istanbul University-Cerrahpaşa
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Mehmet Tugay Yumuk
Istanbul University-Cerrahpaşa
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Hasan Barman
Istanbul University-Cerrahpaşa
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Cagdas Topel
Istanbul Mehmet Akif Ersoy Gogus Kalp Ve Damar Cerrahisi Egitim Ve Arastirma Hastanesi
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Adem Atıcı
Medeniyet Universitesi Goztepe Egitim ve Arastirma Hastanesi
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Ayça Donmez
Istanbul University-Cerrahpaşa
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Serdar Kucukoglu
Istanbul University-Cerrahpaşa
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sait m. dogan
Istanbul University-Cerrahpaşa
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Abstract

Introduction: Mitral annular disjunction (MAD) is a structural abnormality characterized by the systolic detachment of the posterior mitral annulus and the ventricular myocardium. It is usually observed coexistent with mitral valve prolapse(MVP) and associated with a mechanical dysfunction despite preserved electrical isolation function of the mitral annulus. Diagnosis depends on the detection of disjunction by imaging modalities as transthoracic echocardiography or cardiac magnetic resonance imaging (CMRI). This study aimed to evaluate left ventricular (LV) function using speckle tracking echocardiography in MVP patients with MAD. Methods: This study was designed as a prospective, single-center study including 103 patients with MVP and 40 age- and sex-matched control subjects. Transthoracic echocardiography and cardiac magnetic resonance imaging were performed to assess LV function and MAD presence. Results: MAD (+) MVP (n=34), MAD (-) MVP (n=69), and control (n=40) groups were enrolled in the study. Among the MVP patients, 34 (33%) had MAD. T negativity in the inferior leads on electrocardiography was more frequent in the MAD (+) group than in the MAD (-) patients (4.3% vs 20.6%, p=0.014). Mitral regurgitation degree, Pickelhaube sign (17.6% vs. 1.4%, p=0.005), and late gadolinium enhancement frequency (35.3% vs. 10.6%, p=0.002) were significantly higher in MAD (+) patients. MAD (+) patients had significantly impaired global longitudinal strain (GLS) -23.1±2.1 vs. -23.5±2.3, P<0.001), basal longitudinal strain (BLS) (-19.6±1.5 vs -20.5±1.9, P < 0.001), and Mid-Ventricular Longitudinal Strain(MVLS) (-22.2±1.7 vs -23.2±2.2, P<0.001) when compared to MAD (-) MVP patients, despite similar LV ejection fraction. All these values of MVP patients were also significantly lower than the control group. The mean MAD distance was 7.8 ± 3.2 mm in MAD (+) patients. Patients with 2 or more symptoms were higher in the MAD (+) group than in the MAD (-) group (4.3% vs 44.1%, P<0.001). Conclusion: This study demonstrated a significant decrease in longitudinal strain in MVP patients with MAD, indicating myocardial dysfunction. These findings suggest that MAD may contribute to LV dysfunction and highlight the importance of early detection in younger patients. Further research is needed to explore the functional implications and long-term outcomes of MAD.
11 Jun 2023Submitted to Echocardiography
11 Jun 2023Submission Checks Completed
11 Jun 2023Assigned to Editor
14 Jun 2023Reviewer(s) Assigned
13 Jul 2023Review(s) Completed, Editorial Evaluation Pending
14 Jul 2023Editorial Decision: Revise Major
25 Jul 20231st Revision Received
26 Jul 2023Submission Checks Completed
26 Jul 2023Assigned to Editor
26 Jul 2023Reviewer(s) Assigned
08 Aug 2023Review(s) Completed, Editorial Evaluation Pending
30 Aug 2023Editorial Decision: Revise Minor
10 Sep 20232nd Revision Received
10 Sep 2023Submission Checks Completed
10 Sep 2023Assigned to Editor
17 Sep 2023Reviewer(s) Assigned
02 Nov 2023Review(s) Completed, Editorial Evaluation Pending
02 Nov 2023Editorial Decision: Revise Minor
13 Nov 20233rd Revision Received
13 Nov 2023Submission Checks Completed
13 Nov 2023Assigned to Editor
13 Nov 2023Reviewer(s) Assigned
05 Feb 20244th Revision Received
05 Feb 2024Submission Checks Completed
05 Feb 2024Assigned to Editor
05 Feb 2024Review(s) Completed, Editorial Evaluation Pending
05 Feb 2024Editorial Decision: Revise Minor