Introduction
Mitral annular disjunction (MAD) is a structural abnormality of the mitral valve apparatus that is characterized by a separation between the atrial wall of the mitral annulus and the ventricular myocardium (1). This relatively new entity has been increasingly recognized in cardiac imaging studies in recent years and it is shown to be associated with mitral valve prolapse, mitral regurgitation, arrhythmic events, and sudden cardiac death. Its prevalence is found to be over 8% in general population and this number reaches up to four fold in patients with mitral valve prolapse (2).
Abnormal atrial attachment of the posterior leaflet and related systolic curling is observed in MAD which accompanies mechanical annular dysfunction (3). MAD may contribute to mitral valve dysfunction by altering the geometry of the mitral valve annulus or by disrupting the continuity of the subvalvular apparatus (4). Moreover, it has been suggested that MAD may be associated with myocardial dysfunction that can be detected by abnormal myocardial strain. Separation between the atrial wall of the mitral annulus and the ventricular myocardium may disrupt myocardial mechanics, leading to decreased strain (5). Additionally, there may be a direct effect of MAD on the mitral valve, leading to mitral regurgitation and increased afterload on the left ventricle, which may also contribute to myocardial dysfunction (2,5).
There are limited number of studies in the literature that examined the strain parameters in MAD and the information about this subject is not enough to define a particular pattern. In the present study, our aim was to investigate the impact of mitral valve prolapse (MVP) on myocardial strain parameters.