Association of Cardiovascular Events Between Mitral Annular Disjunction and Left Atrial Reservoir Strain in Barlow's Disease

Aims Mitral annular disjunction (MAD) has been suggested to be associated with malignant ventricular arrhythmias and sudden cardiac death. Otherwise, left atrial reservoir strain (LARS) has been reported to be useful in predicting risks of cardiovascular events in heart valve diseases. The current study aimed to investigate the relationship between cardiac events and echocardiographic characteristics in patients with Barlow's disease (BD). Methods and Results Sixty‐nine consecutive patients with BD were enrolled between July 2011 and July 2018. Conventional echocardiographic indices, MAD, severity of mitral regurgitation, parameters of the mitral valve complex, and speckle‐tracking echocardiography were evaluated. The primary endpoint was cardiac events as a composite of cardiac death and non‐sustained ventricular tachycardia (NSVT). MAD was observed in 30 patients out of the 69 patients (43%). During a median follow‐up of 7.3 years, cardiac death and NSVT occurred in nine patients (13%). Although no significant associations were observed among the severity of mitral regurgitation, left atrial volume index, and the morphology of the mitral valve complex, a significant association with cardiac events was identified in relation to the presence of MAD and low LARS (log‐rank test, p < 0.01, respectively) Conclusion The presence of MAD and reduced LARS is significantly associated with an increased risk of cardiac events in patients with BD. These findings highlight the potential importance of MAD and LARS as novel markers for risk stratification in this population.