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May 23, 2026Echocardiography

MR severity linked to ~386% greater LV fibrosis odds in MAD alongside impaired LV GLS.

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Why the study?

Mitral annular disjunction is associated with myocardial fibrosis and malignant arrhythmias, making the identification of predictors of left ventricular fibrosis crucial for risk stratification.

What are the functional and morphological predictors of left ventricular fibrosis in patients with mitral annular disjunction?

Population

60 patients with CMR-confirmed MAD

Comparison

Patients without LV fibrosis vs those with LV fibrosis

Design

Retrospective single-center study

Key result

Severity of mitral regurgitation (OR 4.86) and impaired LV global longitudinal strain (OR 1.44 per 1% reduction) were significant predictors of left ventricular fibrosis in patients with MAD.

Authors

AEAmr Yosry EmamDHDina HarounMAMahmoud Abdelfattah

Discussion

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Overview

MR severity and impaired GLS associated with LV fibrosis in MAD; hypothesis-generating for risk stratification, should not yet change practice.

Key Points

  • The study aims to identify predictors of left ventricular fibrosis in patients with mitral annular disjunction using cardiac magnetic resonance imaging.
  • Retrospective single-center study of 60 patients with CMR-confirmed MAD.
  • Utilized late gadolinium enhancement to identify LV fibrosis and categorized patients into two groups based on fibrosis presence.
  • Compared clinical, volumetric, and strain parameters between groups and performed univariate logistic regression for predictors.
  • Severity of mitral regurgitation was identified as a significant predictor of LV fibrosis (OR = 4.86, p = 0.049).
  • Impaired LV global longitudinal strain was also a significant predictor (OR = 1.44 per 1% reduction, p = 0.034).
  • Markedly impaired biventricular strain measurements were observed in the group with fibrosis.

Study Design

Type

Observational (n=60)

Multicenter

No

Structured PICO

What are the functional and morphological predictors of left ventricular fibrosis in patients with mitral annular disjunction?

P
Population
60 patients with CMR-confirmed mitral annular disjunction (MAD)
I
Intervention
Cardiac magnetic resonance imaging (CMR) with late gadolinium enhancement (LGE) and feature-tracking strain analysis
C
Comparator
Patients without LV fibrosis (n=50) vs. patients with LV fibrosis (n=10)
O
Outcome
Predictors of left ventricular (LV) fibrosissurrogate

Main Result

Effect estimate: OR 4.86 (MR severity); OR 1.44 (LV GLS)

p-value: p=0.049 (MR severity); 0.034 (LV GLS)

In patients with mitral annular disjunction, significant mitral regurgitation and impaired LV global longitudinal strain on CMR are key predictors of myocardial fibrosis.

Cite This Study

Emam et al. (2026) conducted an observational in Mitral annular disjunction (n=60). Cardiac magnetic resonance imaging (CMR) parameters was evaluated on Left ventricular (LV) fibrosis (OR 4.86 (MR severity); OR 1.44 (LV GLS), p=0.049 (MR severity); 0.034 (LV GLS)). Severity of mitral regurgitation (OR 4.86) and impaired LV global longitudinal strain (OR 1.44 per 1% reduction) were significant predictors of left ventricular fibrosis in patients with MAD.

synapsesocial.com/papers/6a1146bb48a409a3a49dff85https://doi.org/10.1111/echo.70512
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