CMR Innovations
Ruby Havistin, MD
Advanced Cardiac Imaging Fellow
West Virginia University
Ruby Havistin, MD
Advanced Cardiac Imaging Fellow
West Virginia University
Mobeen Z. Haider, MD
Advanced Cardiac Imaging Fellow
West Virginia Unviersity
Robert Biederman, MD
Dr
Allegheny General Hospital
Mitral valve prolapse (MVP) has been evaluated for over 100 years. Only recently have we begun to understand why the seemingly unsuspected abnormalities lies within the structural proteins of the mitral valve, including glycosaminoglycans leads to increased morbidity and mortality. Chiefly, this has begun to be understood as abnormalities within the mitral annular structure. Specifically, mitral annular disjunction (MAD) has been shown to be an abnormality not recognized till the advent of improved imaging resolution of the fine mitral articular structure and associated with SCD. We hypothesize that via systematic analysis MAD length is a strong predictor for MACE.
Measurable Goal:
We conducted a systematic search using MeSH terms "mitral valve prolapse," "magnetic resonance imaging," and "echocardiography," which initially identified 285 studies. We then refined our search by adding "mitral annular disjunction" use in the study titles, which yielded 53 studies. We subsequently did a manual review of each reference to identify studies that specifically addressed MAD length and associated outcomes.
15 studies were identified via this MESH search (8 echocardiography and 7 CMR). The studies had a range of 39 to 441 patients with an average of 140. Aged 24 to 73, 52% male. Of these 15 studies, only 2/15 (13%) specifically measured MAD length while incorporating it as a relation to MACE. CMR-MAD length average more than 6 mm was to predict significant MACE. In one paper, for every millimeter increase in MAD length, there was a ~11% increase in MACE.
Current vs. Goal Capabilities:
As our contemporary understanding of MVP has increased, in part due to improved spatial and temporal resolution of Imaging, specifically CMR, greater understanding of the mechanisms of MACE with particular attention to death and SCD have ensued. While our systematic analysis was not sufficiently powered due to lack of specific attempts to interrogate MAD length, available data support a MAD length of more than 6 mm as predictive for hard MACE. More studies are needed to define a threshold length for MAD to justify a considered intervention vs defining a measure of reassurance of low risk.
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