CONGRESS ABSTRACT

Introduction: We report a case correlating Mitral Annular Disjunction (MAD) and Post-systolic-shortening (PSS). Case Report: A 46-year-old male, symptomatic for palpitations. Ventricular extrasystole on ECG, posterior mitral leaflet prolapse, and MAD with normal systolic and diastolic function on Cardiac Echocardiography. We studied speckle tracking,  with demonstration of PSS at the posterior-basal segments of the left ventricle with normal Global Longitudinal Strain. Discussion: MAD is characterized by a systolic separation between the ventricular myocardium and the mitral annulus supporting the posterior mitral leaflet. In patients with MAD, Mitral Valve Prolapse (MVP) is reported in 78% of cases. Among patients with MVP, the prevalence of MAD varies between 20 and 58%. MAD is a predictor of more frequent arrhythmias, and the underlying mechanism is unclear, although myocardial fibrosis is hypothesized as the cause. Post-systolic shortening (PSS) is defined as a delayed systolic shortening occurring after the aortic valve closure. In some studies, Post-systolic shortening has been shown to be superior to global longitudinal strain in predicting adverse events in patients with stable coronary artery disease and preserved systolic function. Currently, this correlation is not widely demonstrated in diseases other than ischemic heart disease. Conclusion: It can be hypothesized that the mechanism behind arrhythmias in MAD is related to PSS; however, further studies are required for confirmation.