Key result
CMR detects bilateral annular disjunction and MVP missed by echo in arrhythmic mitral valve complex.
Why the study?
Arrhythmogenic mitral valve disease carries a high risk of ventricular arrhythmia and sudden cardiac death, creating an urgent need for risk prediction and stratification using different imaging modalities.
Does cardiac magnetic resonance (CMR) improve the diagnosis of arrhythmogenic mitral valve disease in a patient with syncope and non-diagnostic echocardiography?
Case Report (n=1)
No
Does cardiac magnetic resonance (CMR) improve the diagnosis of arrhythmogenic mitral valve disease in a patient with syncope and non-diagnostic echocardiography?
Absolute Event Rate: 1% vs 0%
CMR provides incremental diagnostic value over echocardiography for identifying arrhythmogenic mitral valve disease phenotypes, such as mitral and tricuspid annular disjunction, in patients presenting with syncope.
CMR may warrant use in syncope after nondiagnostic echocardiography for arrhythmogenic mitral valve disease; hypothesis-generating pending larger studies.[[1]](https://pmc.ncbi.nlm.nih.gov/articles/PMC9705142/)[[2]](https://www.escardio.
Arrhythmogenic mitral valve disease (AMVD) is a newly established entity that carries a high risk of developing ventricular arrhythmia ranging from premature ventricular contraction to sudden cardiac death. Therefore, there is an urgent need for risk prediction and stratification by using different imaging modalities. A 77-year-old patient presented with a syncopal episode. Physical examination was unremarkable. Resting electrocardiogram (ECG) was normal. Echocardiography showed mild systolic dysfunction and mild aortic stenosis. Seven days of Holter monitor recording demonstrated frequent episodes of polymorphic ventricular contraction and one episode of sinus bradycardia. Therefore, the patient was scheduled for cardiac magnetic resonance (CMR) which was successful in revealing the etiology of the presentation. Biannuli disjunction and mitral valve prolapse could be clearly visualized in our CMR study. Consequently, the patient was referred for an urgent clinical consultation by the electrophysiology heart team and implantable loop recorder. A review of the six-week recording showed further episodes of narrow complex tachycardia with rates up to 222 beats per minute (bpm) associated with one episode of pre-syncope. He was prescribed bisoprolol and scheduled for regular follow-up at the arrhythmia clinic. In our report, we present a case of AMVD when the definite diagnosis could not be revealed by using the echocardiography modality alone. However, CMR has been proven successful in establishing a diagnosis and unveiling the etiology of the presentation.
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Raslan et al. (2026) conducted a case report in 77-year-old male patient with arrhythmic mitral valve complex phenotype presenting with syncope and ventricular arrhythmias (n=1). Cardiac magnetic resonance (CMR) imaging vs. Transthoracic echocardiography (TTE) was evaluated on Diagnostic accuracy and risk stratification for arrhythmic mitral valve complex and tricuspid annular disjunction.. Cardiac magnetic resonance identified bilateral mitral and tricuspid annular disjunction and mitral valve prolapse not detected by echocardiography, enabling diagnosis and risk stratification in a 77-year-old patient with arrhythmic mitral valve complex.
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