Research Mentor Name

John Dawdy, MD

Research Mentor Email Address

Institution / Department

Department of Internal Medicine, Division of Cardiology, Wayne State University, Detroit, MI

Document Type

Research Abstract

Research Type


Other Type of Research


Level of Research


Type of Post-Bachelor Degree



Background: Mitral annular disjunction (MAD) is an atrial displacement of the mitral valve hinge point. MAD may occur with or without mitral valve prolapse (MVP) and has been linked to ventricular arrhythmias (VA) and sudden cardiac death (SCD). Although cardiac magnetic resonance imaging (cMRI) is the gold standard for MAD detection, it is not practical for screening. We used 2D transthoracic echocardiography (TTE) with speckle tracking echocardiography (STE) to characterize segmental and global longitudinal myocardial strain (SLMS, GLMS) patterns in patients with MAD, +/-MVP.

Methods: 43 subjects were identified by searching “MAD” in our institution’s database. GLMS and SLMS patterns were analyzed by STE, and hospital charts were reviewed to record comorbidities.

Results: 43 MAD patients (36 +MVP and 7 -MVP) were studied using 2D TTE (average MAD distance 9.6 mm, range 3-22mm). 17 (40%) patients had prior VA (average MAD distance 11.6mm, range 6.6-22mm). Average GLMS was -18.2%; attenuated MS was noted in basal inferior, inferoseptal, and anteroseptal segments (-15.2%, -12.5%, and –13.8%, respectively).

Conclusion: It is postulated that MAD causes myocardial fibrosis, leading to arrhythmia. Though MAD can be identified on cMRI, TTE is a better screening test, and STE with MS mapping may offer a novel way of additional characterization.

Clinical Implications: We used TTE with STE for MS mapping to profile GLMS and SLMS in patients with MAD, +/-MVP. Our results show that deranged basal LMS may reflect MAD severity. Future research should optimize screening practices with STE to improve outcomes for patients with MAD.


Medicine and Health Sciences


I would like to thank my mentors, Drs. John Dawdy, Ahmad El-Moussa, and Luis Afonso, for supporting my academic development and fostering my interest in cardiology.