Mitral Valve Disease
Conditions
Keywords
mitral annular disjunction
Brief summary
Observational cohort prospective multicenter study on patients with mitral annular disjunction (MAD). MAD is defined as a separation (≥1 mm) between the atrial wall-mitral valvular junction and the left ventricular free wall during end-systole
Detailed description
Mitral annular disjunction (MAD) is a structural abnormality of the mitral annulus, defined as a separation (≥1 mm) between the atrial wall-mitral valvular junction and the left ventricular free wall during end-systole. This abnormality is significantly associated with the presence of mitral valve prolapse (MVP), but it can also be observed in normal hearts. MAD-related hypermobility of the mitral apparatus and the consequent posterior systolic curling determine a mechanical stress of the infero-basal wall and papillary muscle. This phenomenon leads to myocardial hypertrophy and fibrosis, creating an arrhythmogenic substrate and a source of electrical instability. For this reason, the analysis of left ventricle by cardiac magnetic resonance plays a pivotal role in the identification of predictors of fatal arrhythmic events, such as sudden cardiac death (SCD). Taking into account that MAD could be present without MVP, some studies analyzed the association between MAD and arrhythmic events. They showed that MAD itself is a risk marker of electrical instability supporting the existence of an emerging clinical entity: the MAD arrhythmic syndrome. An in deep analysis of MAD patients and their characteristics in terms of EKG, types of arrhythmia, echocardiographic parameters and cardiac magnetic resonance (CMR) data and long-term events is lacking. The present study is ideated and conducted to fill this gap and collect information regarding management and outcome of patients with MAD
Interventions
OTHERdiagnostic flow
exams to estimate the risk of adverse events in patients with MAD
Sponsors
University Hospital of Ferrara
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
OTHER
Masking
NONE
Intervention model description
Observational cohort prospective multicenter study on patients with MAD
Eligibility
Sex/Gender
ALL
Age
18 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
* Subject aged ≥18 years and \<65 years * Evidence of MAD during routine echocardiography clinically indicated by treating physician for any reason * Written informed consent
Exclusion criteria
• Patient's refusal
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Pathological findings associated with MAD | 3 months | Percentage of subjects with MAD whom deeper analysis with cardiological visit, electrocardiogram (ECG), 24-hour ECG Holter monitoring and cardiac magnetic resonance (CMR) identifies pathological findings. Pathological findings are defined as follows: -T wave inversion in inferolateral leads at ECG * frequent premature ventricular complexes (\>1000/24h) * non-sustained ventricular arrythmias * sustained ventricular arrythmias * severe mitral regurgitation * myocardial fibrosis with a non-ischemic pattern, especially of papillary muscles and inferolateral wall. The primary endpoint will be considered achieved if at least one of the above mentioned paramentrs will be found in the patient |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| surgery for mitral valve | 5 years | occurrence of mitral surgery |
| sudden cardiac death | 5 years | occurrence of sudden cardiac death |
| aborted cardiac arrest | 5 years | occurrence of aborted cardiac arrest |
| ventricular arrhythmia | 5 years | occurrence of non-sustained and/or sustained ventricular tachycardia |
Countries
Italy
Outcome results
None listed