{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T06:48:14Z","timestamp":1782283694762,"version":"3.54.5"},"reference-count":24,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T00:00:00Z","timestamp":1780358400000},"content-version":"vor","delay-in-days":1,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T00:00:00Z","timestamp":1780272000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Eur J Clin Investigation"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Mitral annular disjunction (MAD) is increasingly recognised on cardiac magnetic resonance (CMR) imaging, yet its clinical significance remains under discussion. We aimed to determine the prevalence, prognostic impact, and association with native T1 relaxation time of MAD assessed in both end\u2010systole and end\u2010diastole in an all\u2010comer CMR cohort.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analysed data from 1969 patients enrolled in a prospective CMR registry at the Vienna General Hospital. MAD was defined as \u2265\u20091\u2009mm separation between the left atrial wall at the mitral valve hinge point and the adjacent left ventricular myocardium. Native T1 relaxation times were measured at septal and lateral positions of the mitral annulus in the 4\u2010chamber view. All\u2010cause mortality was analysed by Cox proportional hazards regression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      End\u2010systolic MAD was present in 509 patients (25.9%), end\u2010diastolic in 366 (18.6%). MAD patients were younger (59.6\u2009\u00b1\u200918.5 vs. 65.2\u2009\u00b1\u200917.9\u2009years,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), had fewer comorbidities, and had higher left ventricular ejection fractions (58.8%\u2009\u00b1\u200910.4% vs. 56.8%\u2009\u00b1\u200914.4%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.009). MAD distance correlated with native annular T1 relaxation time (\n                      <jats:italic>r<\/jats:italic>\n                      \u2009=\u20090.24,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), and patients with MAD \u2265\u20095\u2009mm showed higher T1 relaxation time than those &lt;\u20095\u2009mm (1041\u2009\u00b1\u2009148 vs. 1010\u2009\u00b1\u200972\u2009ms,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.028), while mid\u2010septal T1 relaxation time showed no difference (\n                      <jats:italic>r<\/jats:italic>\n                      \u2009=\u20090.06,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.252). During 63.7\u2009months median follow\u2010up, 485 deaths occurred. After multivariable adjustment, end\u2010diastolic MAD was not associated with mortality (HR 0.95, 95%\u2010CI 0.74\u20131.23,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.712).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>MAD is common and prognostically neutral after adjustment. However, larger disjunction distances are associated with higher native T1 relaxation time values at the annulus, suggesting local subclinical myocardial remodelling.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/eci.70235","type":"journal-article","created":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T11:45:32Z","timestamp":1780400732000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Association of Mitral Annular Disjunction on Magnetic Resonance Imaging With Cardiovascular Outcomes"],"prefix":"10.1111","volume":"56","author":[{"given":"Katharina","family":"Mascherbauer","sequence":"first","affiliation":[{"name":"Department of Internal Medicine II, Division of Cardiology Medical University of Vienna  Vienna Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikolai","family":"Nantschev","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine II, Division of Cardiology Medical University of Vienna  Vienna Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina","family":"Kronberger","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine II, Division of Cardiology Medical University of Vienna  Vienna Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6723-005X","authenticated-orcid":false,"given":"Carolina","family":"Don\u00e0","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine II, Division of Cardiology Medical University of Vienna  Vienna Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthias","family":"Koschutnik","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine II, Division of Cardiology Medical University of Vienna  Vienna 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II, Division of Cardiology Medical University of Vienna  Vienna Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Lunzer","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine II, Division of Cardiology Medical University of Vienna  Vienna Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sophia","family":"Koschatko","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine II, Division of Cardiology Medical University of Vienna  Vienna Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charlotte","family":"Jantsch","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine II, Division of Cardiology Medical University of Vienna  Vienna Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregor","family":"Heitzinger","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine II, Division of Cardiology Medical University of Vienna  Vienna Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kseniya","family":"Halavina","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine II, Division of Cardiology Medical University of Vienna  Vienna Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Nitsche","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine II, Division of Cardiology Medical University of Vienna  Vienna Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7519-5274","authenticated-orcid":false,"given":"Franz","family":"Duca","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine II, Division of Cardiology Medical University of Vienna  Vienna 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