Mitral annular disjunction in out-of-hospital cardiac arrest patients—a retrospective cardiac MRI study

Mitral annular disjunction (MAD), defined as defective attachment of the mitral annulus to the ventricular myocardium, has recently been linked to malignant arrhythmias. However, its role and prognostic significance in patients requiring cardiopulmonary resuscitation (CPR) remain unknown. This retrospective analysis aimed to describe the prevalence and significance of MAD by cardiac magnetic resonance (CMR) imaging in out-of-hospital cardiac arrest (OHCA) patients. Eighty-six patients with OHCA and a CMR scan 5 days after CPR (interquartile range (IQR): 49 days before – 9 days after) were included. MAD was defined as disjunction-extent ≥ 1 mm in CMR long-axis cine-images. Medical records were screened for laboratory parameters, comorbidities, and a history of arrhythmia. In 34 patients (40 Study synopsis - MAD occurs frequently in unknown-cause OHCA and represents an independent marker after adjustment for age, hypertension, and hypercholesterolemia. (Illustration created with biorender.com). MAD mitral annular disjunction, OHCA out-of-hospital cardiac arrest