550 Chordal Leaflet-Myocardial Interactions Using Applied Speckle-Tracking Echocardiography in Mitral Valve Prolapse

Abstract

BackgroundThe submitral apparatus maintains annular-papillary continuity and myocardial geometry. In mitral valve prolapse (MVP), elongated chords and redundant leaflets can lead to discordant motion of the basal inferolateral wall. We sought to characterize chordal leaflet-myocardial interactions using speckle tracking echocardiography at rest and at stress, stratified by severity of prolapse.Methods/Results30 consecutive patients with MVP and matched controls underwent stress echocardiography. The prespecified endpoint was the difference between time to peak transverse displacement (TTPD) of the inferolateral wall compared to the anteroseptal wall using speckle tracking echocardiography. Results were analysed as raw data, normalized to the RR interval, and as a percentage of the maximal displacement of the anteroseptal segment(s). Intraobserver and interobserver variability were assessed using the Bland-Altman approach. Compared to controls, cases demonstrated significant delay at rest and at peak stress (p<0.003 - <0.0001). When stratified by severity of prolapse, TTPD results were significant in mild, but not severe, MVP. Rest TTPD had modest correlation with peak stress TTPD for controls (r=0.56; p= 0.007).Conclusion BackgroundThe submitral apparatus maintains annular-papillary continuity and myocardial geometry. In mitral valve prolapse (MVP), elongated chords and redundant leaflets can lead to discordant motion of the basal inferolateral wall. We sought to characterize chordal leaflet-myocardial interactions using speckle tracking echocardiography at rest and at stress, stratified by severity of prolapse. The submitral apparatus maintains annular-papillary continuity and myocardial geometry. In mitral valve prolapse (MVP), elongated chords and redundant leaflets can lead to discordant motion of the basal inferolateral wall. We sought to characterize chordal leaflet-myocardial interactions using speckle tracking echocardiography at rest and at stress, stratified by severity of prolapse. Methods/Results30 consecutive patients with MVP and matched controls underwent stress echocardiography. The prespecified endpoint was the difference between time to peak transverse displacement (TTPD) of the inferolateral wall compared to the anteroseptal wall using speckle tracking echocardiography. Results were analysed as raw data, normalized to the RR interval, and as a percentage of the maximal displacement of the anteroseptal segment(s). Intraobserver and interobserver variability were assessed using the Bland-Altman approach. Compared to controls, cases demonstrated significant delay at rest and at peak stress (p<0.003 - <0.0001). When stratified by severity of prolapse, TTPD results were significant in mild, but not severe, MVP. Rest TTPD had modest correlation with peak stress TTPD for controls (r=0.56; p= 0.007). 30 consecutive patients with MVP and matched controls underwent stress echocardiography. The prespecified endpoint was the difference between time to peak transverse displacement (TTPD) of the inferolateral wall compared to the anteroseptal wall using speckle tracking echocardiography. Results were analysed as raw data, normalized to the RR interval, and as a percentage of the maximal displacement of the anteroseptal segment(s). Intraobserver and interobserver variability were assessed using the Bland-Altman approach. Compared to controls, cases demonstrated significant delay at rest and at peak stress (p<0.003 - <0.0001). When stratified by severity of prolapse, TTPD results were significant in mild, but not severe, MVP. Rest TTPD had modest correlation with peak stress TTPD for controls (r=0.56; p= 0.007). Conclusion