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Mitral annulus disjunction: Is it a marker of ominous prognosis?
Session:
Posters - B. Imaging
Speaker:
Catarina Oliveira
Congress:
CPC 2021
Topic:
B. Imaging
Theme:
03. Imaging
Subtheme:
03.1 Echocardiography
Session Type:
Posters
FP Number:
---
Authors:
Catarina Simões De Oliveira; Joana Rigueira; Tiago Rodrigues; Nelson Cunha; Pedro Silvério António; Sara Couto Pereira; Joana Brito; Beatriz Valente Silva; Pedro Alves da Silva; Beatriz Garcia; Ana Margarida Martins; Claudio David; Fausto j. Pinto; Ana Almeida
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Introduction: Mitral annulus disjunction (MAD) has been proposed as a contributing factor for arrythmias and mitral regurgitation in patients (pts) with mitral valve prolapse (MVP), however its clinical relevance is still under investigation.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Objective: To evaluate the prevalence of MAD in MVP pts, to characterize clinically patients with MAD and assess potential markers for events.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Methods: Single-center retrospective study of consecutive patients with MVP documented in transthoracic echocardiogram between January 2014 and October 2019. MVP was defined according to the 2017 AHA recommendations; MAD was defined as a separation between mitral valve annulus and the left ventricle free wall. Demographic, clinical, echocardiographic, electrocardiographic data were collected. The results were obtained using Chi-square and Mann-Whitney tests; logistic regression was used to find predictors of events.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Results: Two hundred forty seven pts were included (mean age 62.9 ± 18 years, 61% males), MAD was present in 23 (9.3%), (mean age 56±20 years, 56.5% males). The maximum diameter of MAD was 10±3mm (range 5-18), mitral regurgitation was present in 21 patients (92.3%), at least of moderate severity in 65.2% pts. Most of the patients (91.3, n=21) were in sinus rhythm (SR). </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">During follow-up (FUP) of 29 ± 19 months, 39% (n=9) pts developed symptoms, 22% (n=5) developed atrial fibrillation (AF), 4.3% (n=1) had acute aortic syndrome (AAS), 4.3% (n=1) required ICD implantation, 22% (n=5) undergone mitral valve intervention, 8.7% (n=2) were hospitalized and 8.7% (n=2) died. None of the patients presented sustained ventricular arrhythmias (SVA) assessed by regular Holter monitoring.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Patients with MAD developed more AAS and required more ICD implantation in FUP when compared to patients without MAD (p=0.007 and p=0.006, respectively).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Mitral cord rupture (p=0.04), age (p=0.044), maximum velocity of tricuspid regurgitation (p=0.04) and interventricular septum (IVS) thickness (p=0.017) were associated with AF in MAD patients. On univariate analysis, IVS thickness was a predictor of AF in this subgroup (OR 4.0, 95%CI 1.1-14.3, p=0-032). Presence of SR predicted survival (p=0.03). </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">No predictors of hospital admission or mitral intervention were found.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Conclusion: Patients with MAD had a relatively benign prognosis with few events during follow-up, although with more AAS and ICD in FUP. In our sample, AF was more common than SVA. Left ventricle hypertrophy was a predictor of AF and sinus rhythm was associated with survival. Larger studies with more patients and other methods of imaging are needed to confirm our results.</span></span></p>
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