Evidence map›Paper›PMID 40962209›Full record

ArticleJournal of the American Society of Echocardiography : official publication of the American Society of Echocardiography2026

Sex-Based Differences in Mitral Annular Disjunction Severity and Arrhythmic Risk in Mitral Valve Prolapse.

Luca Cristin, Lionel Tastet, Rohit Jhawar, Amy B Rich, Janet J Tang, Dwight Bibby, Qizhi Fang, Farzin Arya, Francesca N Delling

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Article in Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

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2citing papers in PubMed
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1 · What the graph read from it

What it found

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2 · The registry

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3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

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4 · The record

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5 · Who and what money

Authors and funding

9 authors.

Luca CristinDepartment of Medicine (Cardiovascular Division), University of California, San Francisco, California.
Lionel TastetDepartment of Medicine (Cardiovascular Division), University of California, San Francisco, California.
Rohit JhawarDepartment of Medicine (Cardiovascular Division), University of California, San Francisco, California.
Amy B RichDepartment of Medicine (Cardiovascular Division), University of California, San Francisco, California.
Janet J TangDepartment of Medicine (Cardiovascular Division), University of California, San Francisco, California.
Dwight BibbyDepartment of Medicine (Cardiovascular Division), University of California, San Francisco, California.
Qizhi FangDepartment of Medicine (Cardiovascular Division), University of California, San Francisco, California.
Farzin AryaDepartment of Medicine (Cardiovascular Division), University of California, San Francisco, California.
Francesca N DellingDepartment of Medicine (Cardiovascular Division), University of California, San Francisco, California. Electronic address: Francesca.Delling@ucsf.edu.

Funding

Prospective sudden cardiac death risk stratification using CMR and echocardiography machine learning in mitral valve prolapseR01HL153447 · NHLBI · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI DELLING, FRANCESCA N · 2020 to 2024
$4.7M
NHLBI NIH HHS R01 HL153447
6 · The paper itself

Abstract

backgroundArrhythmic mitral valve prolapse (AMVP), a condition with known female predominance, has been linked to mitral annular disjunction (MAD), yet the relationship between MAD, sex, body size, and arrhythmic events remains unclear.

objectivesTo determine whether MAD exhibits sex-based differential effects on arrhythmic risk and explore the implications of indexing MAD measurements.

methodsWe examined 682 consecutive MVPs at the University of California San Francisco (2013-23) with detailed clinical, rhythmic, and echocardiographic data. Mitral annular disjunction was indexed to body surface area, resulting in the identification of 3 distinct groups: no MAD and indexed MAD (iMAD) below and iMAD above the median. Arrhythmic mitral valve prolapse was defined as MVP with frequent and/or complex ventricular ectopy, including severe arrhythmic events such as sustained ventricular tachycardia, ventricular fibrillation/sudden cardiac arrest, or death.

resultsAmong 682 MVP patients (48% women, mean age 58 ± 17 years), 35% had AMVP and 41% had MAD, with a median iMAD of 4 mm. Compared to women, men had greater absolute MAD length (9.0 ± 3.2 mm vs 7.3 ± 2.6, P < .001). Sex-based differences in MAD length were no longer appreciated after indexing for body surface area (P = .33). In multivariable analyses, iMAD >4 mm was significantly associated with arrhythmic events in men but not in women (P = .02 vs P = .63). Bileaflet MVP had a direct effect on severe arrhythmic events in women (P = .04 for MVP, P = .39 in mediation analysis), but in men this association was mediated by iMAD length (P = .03).

conclusionIn a large MVP cohort, men exhibit greater MAD length and a stronger association between iMAD length and arrhythmic events. In contrast, iMAD length in women may be less important for arrhythmic risk stratification compared to other imaging parameters such as bileaflet involvement. Further studies are needed to confirm alternative mechanisms beyond localized MAD-related myocardial traction in women with MVP.

Indexed as

Arrhythmias, CardiacEchocardiographyMitral ValveMitral Valve ProlapseFemaleHumansMaleMiddle AgedRisk AssessmentRisk FactorsSeverity of Illness IndexSex DistributionSex FactorsArrhythmiaMitral annular disjunctionMitral valve prolapseSex-based differences

Identifiers

PMID40962209
PMCPMC13267047

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.