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. 2023 Apr 20;10(4):181.
doi: 10.3390/jcdd10040181.

Left Ventricle Segmental Longitudinal Strain and Regional Myocardial Work Index Could Help Determine Mitral Valve Prolapse Patients with Increased Risk of Ventricular Arrhythmias

Ludmiła Daniłowicz-Szymanowicz  1 , Agnieszka Zienciuk-Krajka  1 , Elżbieta Wabich  1 , Marcin Fijałkowski  2 , Jadwiga Fijałkowska  3 , Krzysztof Młodziński  1 , Grzegorz Raczak  1
Affiliations

Left Ventricle Segmental Longitudinal Strain and Regional Myocardial Work Index Could Help Determine Mitral Valve Prolapse Patients with Increased Risk of Ventricular Arrhythmias

Ludmiła Daniłowicz-Szymanowicz et al. J Cardiovasc Dev Dis. .

Abstract

Mitral valve prolapse (MVP) could associate with malignant ventricular arrhythmias (VAs). Mitral annular disjunction, a putative mechanism for an arrhythmic substrate, leads to excessive mobility, stretch, and damage of some segments. Speckle tracking echocardiography (STE), with particular attention to the segmental longitudinal strain and myocardial work index (MWI), could be an indicator of the segments we aimed to check. Seventy-two MVP patients and twenty controls underwent echocardiography. Complex VAs documented prospectively after the enrollment was qualified as the primary endpoint, which was noticed in 29 (40%) patients. Pre-specified cut-off values for peak segmental longitudinal strain (PSS) and segmental MWI for basal lateral (-25%, 2200 mmHg%), mid-lateral (-25%, 2500 mmHg%), mid-posterior (-25%, 2400 mmHg%), and mid-inferior (-23%, 2400 mmHg%) segments were accurate predictors of complex VAs. A combination of PSS and MWI increased the probability of the endpoint, reaching the highest predictive value for the basal lateral segment: odds ratio 32.15 (3.78-273.8), p < 0.001 for PSS ≥ -25% and MWI ≥ 2200 mmHg%. STE may be a valuable tool for assessing the arrhythmic risk in MVP patients. Excessively increased segmental longitudinal strain with an augmented regional myocardial work index identifies patients with the highest risk of complex VAs.

Keywords: longitudinal strain; mitral valve prolapse; myocardial work; nonsustained ventricular tachycardia; speckle tracking echocardiography.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Transthoracic echocardiography (long-axis parasternal view) of MAD measurement in MAD+ patients. MAD distance is calculated as the length of systolic separation between the left atrial wall and mitral valve leaflet junction to the top of the left ventricle free wall.
Figure 2
Figure 2
The presentation of the Pickelhaube sign (yellow arrow) as a spiked configuration of basolateral annular tissue Doppler imaging presentation (left panel). The presentation of S′ value of basolateral annular tissue Doppler imaging in patient without Pickelhaube sign (right panel).
Figure 3
Figure 3
The example of representative case with speckle-tracking analysis including MAD area.
Figure 4
Figure 4
Flow chart of screened, included and excluded MVP patients.
Figure 5
Figure 5
Peak Segmental Strain comparisons between MAD+, MAD− and Healthy groups in sixteen segments.
Figure 6
Figure 6
Myocardial Work Index comparisons between MAD+, MAD− and Healthy groups in sixteen segments.
Figure 7
Figure 7
The example of the “Bull’s-eye” representation (obtained from long-axis, 2- and 4-chamber apical views) of regional strains in the MAD+ patient. Arrows present basal lateral segment with augmented (more negative) values of longitudinal strain (yellow arrow) and myocardial work index (red arrow).
Figure 8
Figure 8
The example of the “Bull’s-eye” representation (obtained from long-axis, 2- and 4-chamber apical views) of regional strains in the MAD− patient. Arrows present basal lateral segment with normal (not augmented) values of longitudinal strain (yellow arrow) and myocardial work index (red arrow).
Figure 9
Figure 9
The example of the “Bull’s-eye” representation (obtained from long-axis, 2- and 4-chamber apical views) of regional strains in the MAD+ patient. Panel (A) presents the basal lateral segment with augmented values of longitudinal strain and MWI (marked segment). Panel (B) present basal septal segment with lower values of longitudinal strain and myocardial work index (marked segment).
Figure 10
Figure 10
ROC curves of 2D GLS and MAD distance (panel (A)) and 2D peak segmental strain and segmental MWI parameters (panel (B)).
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