A tale of two MADs: a case series
Bibliographic record
Abstract
Background: Mitral annular disjunction (MAD), consisting in a systolic separation between the posterior atrial wall-leaflet junction and the basal left ventricular wall, is a disputed imaging entity. MAD was initially associated with sudden cardiac death and ventricular arrhythmias in patients with mitral valve prolapse, whereas in more recent studies, it has been presented as a normal variant of the mitral annulus. Case summary: In the present series of two cases, we show a case featuring a young woman with syncope that showed a microscopic MAD on echocardiography but, after a thorough multimodality assessment, was diagnosed with a coronary anomaly responsible for her presentation. In the second case, a young man presenting with aborted sudden cardiac death was found to have a macroscopic MAD in the context of mitral valve prolapse with numerous high-risk arrhythmic features. Discussion: The need for assessing the diverse significance of MAD in the clinical and imaging context of each patient is underscored. Assessment of MAD should be complemented by other imaging and clinical parameters: the circumferential and longitudinal extent of MAD, the presence of repolarization abnormalities or ventricular arrhythmias, bi-leaflet prolapse, systolic curling, the Pickelhaube sign, left heart remodelling, and the presence of myocardial fibrosis, among others.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.005 |
| Meta-epidemiology (narrow) | 0.003 | 0.002 |
| Meta-epidemiology (broad) | 0.002 | 0.002 |
| Bibliometrics | 0.006 | 0.003 |
| Science and technology studies | 0.005 | 0.003 |
| Scholarly communication | 0.003 | 0.004 |
| Open science | 0.002 | 0.005 |
| Research integrity | 0.006 | 0.004 |
| Insufficient payload (model declined to judge) | 0.005 | 0.002 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".