210 | Chapter 10 DISCUSSION Our study is the first to compare prevalence of MAD and MVP in a consecutive multicenter cohort of IVF patients to a healthy control population. The most important finding was the increased prevalence of MAD in the inferolateral wall and MVP compared to controls (Figure 3). Subjects with MAD in the inferolateral wall also showed high prevalence of other mitral valve disease and ventricular ectopy. This is in line with previous studies suggesting a correlation between mitral valve disease and IVF. MAD in the anterior, inferior and anterolateral wall was commonly measured in both IVF patients and healthy controls. Figure 3. Prevalence of MAD and MVP in IVF patients compared to healthy controls In total, 144 patients were enrolled in the study; 72 idiopathic ventricular fibrillation (IVF) patients and 72 healthy controls. All patients were screened for presence of mitral annulus disjunction (MAD) and mitral valve prolapse (MVP) on CMR by two blinded observers. MAD in the inferolateral wall was more prevalent in IVF patients compared to controls (p = 0.024). MVP was also more prevalent in IVF patients compared to controls (p = 0.016). Location of mitral annulus disjunction Previous studies showed that MAD distance can vary considerably along the annulus circumference. This was shown with an extensive CMR protocol design assessing the mitral annulus every 30 degrees.8 Although we did not assess the mitral annulus every 30 degrees due to unavailability of these acquisitions or 3D CMR data in this retrospective study, we also observed considerable differences in longitudinal MAD distance over the mitral annulus (Table 3). The aforementioned study showed that MAD located in the inferolateral wall assessed by CMR was an independent risk marker for ventricular arrhythmias.8 In our cohort, the inferolateral
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