Toggle Main Menu Toggle Search

Open Access padlockePrints

Mitral Annular Disjunction Assessed Using CMR Imaging: Insights From the UK Biobank Population Study

Lookup NU author(s): Professor Bob Anderson



This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


© 2022 The AuthorsBackground: Mitral annular disjunction is the atrial displacement of the mural mitral valve leaflet hinge point within the atrioventricular junction. Said to be associated with malignant ventricular arrhythmias and sudden death, its prevalence in the general population is not known. Objectives: The purpose of this study was to assess the frequency of occurrence and extent of mitral annular disjunction in a large population cohort. Methods: The authors assessed the cardiac magnetic resonance (CMR) images in 2,646 Caucasian subjects enrolled in the UK Biobank imaging study, measuring the length of disjunction at 4 points around the mitral annulus, assessing for presence of prolapse or billowing of the leaflets, and for curling motion of the inferolateral left ventricular wall. Results: From 2,607 included participants, the authors found disjunction in 1,990 (76%) cases, most commonly at the anterior and inferior ventricular wall. The authors found inferolateral disjunction, reported as clinically important, in 134 (5%) cases. Prolapse was more frequent in subjects with disjunction (odds ratio [OR]: 2.5; P = 0.02), with positive associations found between systolic curling and disjunction at any site (OR: 3.6; P < 0.01), and systolic curling and prolapse (OR: 71.9; P < 0.01). Conclusions: This large-scale study shows that disjunction is a common finding when using CMR. Disjunction at the inferolateral ventricular wall, however, was rare. The authors found associations between disjunction and both prolapse and billowing of the mural mitral valve leaflet. These findings support the notion that only extensive inferolateral disjunction, when found, warrants consideration of further investigation, but disjunction elsewhere in the annulus should be considered a normal finding.

Publication metadata

Author(s): Zugwitz D, Fung K, Aung N, Rauseo E, McCracken C, Cooper J, El Messaoudi S, Anderson RH, Piechnik SK, Neubauer S, Petersen SE, Nijveldt R

Publication type: Article

Publication status: Published

Journal: JACC: Cardiovascular Imaging

Year: 2022

Volume: 15

Issue: 11

Pages: 1856-1866

Print publication date: 01/11/2022

Online publication date: 19/10/2022

Acceptance date: 13/07/2022

Date deposited: 29/11/2022

ISSN (print): 1936-878X

ISSN (electronic): 1876-7591

Publisher: Elsevier Inc.


DOI: 10.1016/j.jcmg.2022.07.015

PubMed id: 36280553


Altmetrics provided by Altmetric


Funder referenceFunder name
Dr Aung recognizes the NIHR Integrated Academic Training program
British Heart Foundation
Data to Early Diagnosis and Precision Medicine strand of the government’s Industrial Strategy Challenge Fund
Dr Neubauer acknowledges support from the Oxford NIHR Biomedical Research Centre and the Oxford British Heart Foundation Centre of Research Excellence
Dr Nijveldt has received research grants from Philips Volcano and Biotronik.
Dr Petersen provides consultancy to Circle Cardiovascular Imaging, Inc.
Dr Zugwitz acknowledges funding received from the European Society of Cardiology
Drs McCracken and Neubauer are supported by the Oxford NIHR Biomedical Research Centre.
Drs Petersen and Rauseo acknowledge support by the London Medical Imaging and Artificial Intelligence Centre for Value Based Healthcare (AI4VBH)
Innovate UK on behalf of United Kingdom Research and Innovation (UKRI)
Medical Research Council eMedLab Medical Bioinformatics infrastructure, supported by the Medical Research Council (MR/L016311/1)
the European Union’s Horizon 2020 research and innovation program under grant agreement number 825903 (euCanSHare project, Dr Petersen).