Cardiovascular

Mitral Annular Disjunction: Regional Strain Abnormalities Associated With Life-Threatening Ventricular Arrhythmias.

Awadelkarim A, Inampudi J, et al. • Echocardiography (Mount Kisco, N.Y.) • 2026

TL;DR

In 69 patients with echocardiographically confirmed MAD, impaired mid-inferolateral segmental longitudinal strain, but not global longitudinal strain, was associated with life-threatening ventricular arrhythmias, though the authors describe these findings as exploratory and hypothesis-generating.

Key Findings

Results

Mid-inferolateral segmental strain was significantly worse in MAD patients with life-threatening arrhythmias (LTA) than in those without.

Median mid-inferolateral strain was -12.6% (IQR 13.5) in arrhythmic patients vs. -18.9% (IQR 6.0) in non-arrhythmic patients (p = 0.0069).
Differences between groups localized specifically to the inferolateral region at the mid-ventricular level.
Strain was measured by 2D speckle-tracking echocardiography in 69 retrospectively studied patients with MAD.

Results

Global longitudinal strain did not differ significantly between MAD patients with and without arrhythmias.

All patients had preserved LV ejection fraction.
Only regional (segmental) strain, not global strain, distinguished the groups.
The authors suggest regional deformation may add risk stratification beyond global measures.

Results

On exploratory multivariate analysis, mid-inferolateral strain impairment was independently associated with LTA.

Odds ratio was 1.11 per 1% strain increase (p = 0.012).
Univariate and multivariate logistic regression were used to identify independent predictors of arrhythmia.
The authors label the multivariate analysis exploratory.

Results

In univariate models, several clinical and echocardiographic factors were associated with arrhythmias.

Associated factors included larger LV chamber diameters, greater MAD distance, a history of syncope, and worse strain in the mid-inferior and mid-inferolateral segments.
Patients with arrhythmias showed trends toward larger chamber dimensions and a larger MAD distance.

Conclusions

The authors conclude the findings are hypothesis-generating and need confirmation in larger prospective cohorts.

The study was retrospective with 69 patients.
Independent validation is required to ascertain clinical utility.

What This Means

Mitral annular disjunction (MAD) is a structural heart abnormality where the ring around the mitral valve is detached from the heart muscle. It has been linked to dangerous heart rhythm problems, but doctors lack good ways to tell which patients are at highest risk. This study looked back at 69 patients with MAD seen on echocardiograms, all with normal pumping function, and compared those who had life-threatening arrhythmias with those who did not. Overall measures of heart muscle stretching (global longitudinal strain) did not differ between the groups. However, a specific area of the heart wall, the mid-level inferolateral segment, moved much less normally in patients with dangerous arrhythmias (median strain -12.6% vs. -18.9%). Impairment in this area remained linked to arrhythmias after statistical adjustment. Larger heart chambers, a greater MAD distance, and a history of fainting were also associated with arrhythmias in simpler analyses. This research suggests that looking at regional strain, not just whole-heart measures, might help identify MAD patients at higher arrhythmia risk. However, the study was small, retrospective, and exploratory, so the findings need confirmation in larger prospective studies before they could be used in clinical practice.

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Citation

Awadelkarim A, Inampudi J, Kahe F, Gallagher J, Sandles A, Dawdy J, et al.. (2026). Mitral Annular Disjunction: Regional Strain Abnormalities Associated With Life-Threatening Ventricular Arrhythmias.. Echocardiography (Mount Kisco, N.Y.). https://doi.org/10.1111/echo.70652

Key Findings

What This Means

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