In order to bring you the best possible user experience, this site uses Javascript. If you are seeing this message, it is likely that the Javascript option in your browser is disabled. For optimal viewing of this site, please ensure that Javascript is enabled for your browser.

This content is currently on FREE ACCESS, enjoy another 18 days of free consultation

In these unprecedented times, the ESC is doing everything it can to support its community: FREE access to all ESC 365 content until 31 July: explore more than 125,000 educational resources.

From 1 August onwards, support our mission by becoming a member.

Mitral annulus disjunction is associated with severe ventricular arrhythmias independently of mitral valve prolapse

Session Poster Session 6

Speaker Lars Andreas Dejgaard

Event : ESC Congress 2018

  • Topic : valvular, myocardial, pericardial, pulmonary, congenital heart disease
  • Sub-topic : Myocardial Disease: Clinical, Other
  • Session type : Poster Session

Authors : LA Dejgaard (Oslo,NO), ET Skjolsvik (Oslo,NO), OH Lie (Oslo,NO), M Ribe (Oslo,NO), MK Stokke (Oslo,NO), F Hegbom (Oslo,NO), ES Scheirlynck (Oslo,NO), E Gjertsen (Drammen,NO), K Andresen (Drammen,NO), TM Helle-Valle (Oslo,NO), E Hopp (Oslo,NO), T Edvardsen (Oslo,NO), KH Haugaa (Oslo,NO)

L.A. Dejgaard1 , E.T. Skjolsvik1 , O.H. Lie1 , M. Ribe2 , M.K. Stokke2 , F. Hegbom2 , E.S. Scheirlynck2 , E. Gjertsen3 , K. Andresen3 , T.M. Helle-Valle2 , E. Hopp4 , T. Edvardsen1 , K.H. Haugaa1 , 1Oslo University Hospital, Rikshospitalet, Dept of Cardiology and Center for Cardiological Innovation and University of Oslo - Oslo - Norway , 2Oslo University Hospital, Rikshospitalet, Dept of Cardiology and Center for Cardiological Innovation - Oslo - Norway , 3Vestre Viken Hospital Trust, Drammen Hospital, Dept of Medicine - Drammen - Norway , 4Oslo University Hospital, Rikshospitalet, Division of Radiology and Nuclear Medicine and Center for Cardiological Innovation - Oslo - Norway ,

European Heart Journal ( 2018 ) 39 ( Supplement ), 1122-1123

Background: Mitral valve prolapse (MVP) has been associated with sudden cardiac death. Mitral annulus disjunction (MAD) is an abnormal atrial displacement of the mitral valve leaflet hinge point, and has been proposed as a marker for sudden cardiac death in MVP patients. However, risk of ventricular arrhythmias in MAD itself, and in the absence of MVP, is poorly described.

Purpose: To describe the clinical presentation and prevalence of severe ventricular arrhythmias in patients with MAD with and without MVP.

Methods: We included consecutive patients from two hospitals with MAD defined as disjunction of >1 mm by study echocardiogram. We performed clinical examination and evaluated medical records for previous history of severe arrhythmic events, defined as aborted cardiac arrest or sustained ventricular tachycardia. Patients were excluded if they had non-mitral valvular disease, cardiomyopathies, channelopathies or obstructive coronary artery disease. We recorded the presence of MVP, measured MAD in the posterolateral wall (figure) in parasternal long-axis view, and measured left ventricular ejection fraction (EF).

Results: We included 115 patients (49±15 years, 60% female) with confirmed MAD. Severe arrhythmic events had occurred in 14 (12%) patients (n=10 aborted cardiac arrest, n=4 sustained ventricular tachycardia). Reported symptoms were palpitations (71%), presyncope (41%), chest pain (28%) and syncope (13%), with no difference between patients with or without severe arrhythmic events. Patients with severe arrhythmic events were younger (37±13 years vs. 51±14 years, p=0.001) and had lower EF (51±5% vs. 57±7%, p=0.002) compared to patients without events. MVP was evident in 63 (54%) patients and was less frequent in patients with severe arrhythmic events (4 (29%) vs. 59 (58%), p=0.04). In a multivariable logistic regression model including EF, age and MVP, lower EF (Adjusted OR 0.86 (95% CI, 0.77–0.97, p=0.01)) and lower age (Adjusted OR 0.94 (95% CI, 0.89–0.98, p=0.006) remained independent markers for severe arrhythmic events.

Conclusions: Patients with MAD frequently presented with arrhythmic symptoms, and 12% had experienced severe arrhythmic events. MVP was found in only half of the patients with MAD and was not associated with arrhythmic events, indicating MAD itself as an arrhythmogenic entity. In patients with MAD, lower age and EF were markers of severe arrhythmic events.

MVP in MAD with severe arrhythmic events

Based on your interests

Members get more

Join now
  • 1ESC Professional Members – access all resources from general ESC events 
  • 2ESC Association Members (Ivory, Silver, Gold) – access your Association’s resources
  • 3Under 40 or in training - with a Combined Membership, access all resources
Join now

Our sponsors

ESC 365 is supported by Bayer, Boehringer Ingelheim and Lilly Alliance, Bristol-Myers Squibb and Pfizer Alliance, Novartis Pharma AG and Vifor Pharma in the form of educational grants. The sponsors were not involved in the development of this platform and had no influence on its content.

logo esc

Our mission: To reduce the burden of cardiovascular disease

Who we are