921 GLOBAL AND SEGMENTAL LONGITUDINAL STRAIN OF THE LEFT VENTRICLE IN THE STRATIFICATION OF ARRHYTHMIC MITRAL VALVE PROLAPSE

Abstract

Abstract Background and aim Mitral valve prolapse (MVP) is a common benign valvular disease though with an incidence of 0.2-1.9%/year of sudden cardiac death (SCD) related to complex ventricular arrhythmias in the form of arrhythmic MVP (AMVP). In MVP, first diagnostic approach is transthoracic echocardiography (TTE) that should be used to described morphological and functional valvular features and also the presence of mitral annular disjunction (MAD) which seems associated with AMVP. The aim of our study is to describe the association between advanced TTE markers of myocardial stretching such as global and focal longitudinal strain (GLS) and ventricular arrhythmias in MVP patients with and without MAD. Methods 88 patients with MVP were prospectively enrolled. All of them underwent 12-lead ECG and TTE including global and focal GLS of the left ventricle. In addiction, 40 had 24-hour Holter. Results MAD + patients were younger than MAD - (32.22±12.49 vs 41.64±15, p= 0.007) and mostly were females (30 females vs 9 males, p= 0.027). MAD + patients had higher burden of complex ventricular arrhythmias such as premature ventricular contractions (PVCs) with right bundle branch block (RBBB) morphology, bigeminy, non-sustained ventricular tachycardia (NSVT) and VT (Figure A). MAD + group had higher GLS (mean -21.5%±3% vs -20%±2.7%, p=0.0153) with notable difference in the inferior wall GLS (-19.4%±8% vs -16.4%±8%, p= 0.045), figure B. Conclusions Increased global and inferolateral GLS of left ventricle indicates longitudinal deformation in segments exposed to greater tension and mechanical stress by prolapsing leaflets and MAD which are associated with higher arrhythmogenic burden. Advanced echocardiographic techniques, such as global and segmental GLS could be considered as an advanced tool in the arrhythmic stratification of MVP patients.