Left ventricular mechanics during isolated mitral valve prolapse

Abstract

Abnormalities of the valvular and subvalvular apparatus in mitral valve prolapse (MVP) may influence left ventricular (LV) mechanics. To evaluate LV mechanics and ventriculo-valvular interaction in patients with isolated MVP. A single-center study prospectively recruiting adult patients with isolated MVP or minimal systolic displacement (MSD) as well as control population. Potential factors for impaired left ventricular function, including all heart disease, as well as arterial hypertension, diabetes and obesity, were excluded. A complete two-dimensional echocardiography was performed, with analysis of the regional and global longitudinal strain (GLS) and specific mitral valve measurements. The results were compared between the 3 groups and the determinants of the myocardial deformation were sought. 122 patients with an isolated MVP, 91 with a MSD and 229 controls were included. There was no significant difference in terms of volume or overall hypertrophic remodeling. In the MVP group, there was a significant increase of the GLS (controls −20.1 ± 2.5% vs. MVP −21.3 ± 2.2%, P < 0.05, MSD −20.7 ± 2.3%), LVEF (controls 62.3 ± 5.4% vs. MVP 63.9 ± 5.6%, P < 0.05, MSD 63.4 ± 5.5%) and systolic ejection volume (controls: 40.7 ± 7.6 versus MVP 42.8 ± 7.8 ml/m 2 , MSD 41.7 ± 7.6 ml/m 2 ). In MVP population, there was a regional increase of longitudinal strain in the lateral and posterior walls. GLS values were correlated with the extent of prolapse (area under the valve: β = 0.24, P < 0.0001) ( Fig. 1 ). In the absence of other confounding factors, such as mitral insufficiency, structural and functional abnormalities specific to MVP influence left ventricular mechanics, particularly longitudinal strain values.