Abstract
Abstract Background and Purpose Abnormality in the motion of the inferior papillary muscle was found, in the past, in Mitral Valve Prolapse (MVP). We visually observed an odd movement not only in the inferior wall but also in the anterolateral and inferolateral basal walls in several MVP patients as well. Therefore, the purpose of this work was to analyze this findings with the help of Strain (Speckle Tracking). Methods 60 MVP patients, having a superior displacement of the posterior leaflet of at least 2 mm, and 20 normal controls were included. Longitudinal Strain was calculated in the 3 apical views (Philips iE 33 Matrix - implemented Strain software). The Strain in the 3 above mentioned basal segments was measured at 160 msec from the beginning of systole (mid-systole) and then averaged to form a "triad" that could be compared among the groups for statistical calculations. The Global Longitudinal Strain (GLS) was calculated for all as well. The Mann-Whitney U-test for comparisons was used. A "p" value ≤ 0.05 was considered significant. Results According with the Strain patterns, we could identify two Groups of MVP patients: Group 1: having a "paradoxical" Strain at 160 msec (positive, that means stretching) in at least one of the three told basal segments (n = 35), and Group 2 : not having a "paradoxical" Strain (n = 25) in any of the told three basal segments at the same mid-systolic point. Statistical significance was found between Groups 1 and 2 at 160 msec (fig 1) and at the peak (p< 0.0001 for both) and for GLS (p< 0.01) as well. Group 1 vs controls also displayed significant difference in the Strain at 160 msec (p<0,0001) while Group 2 vs controls did not do and even not at the peak (bull-eye summary view in fig 2 ). Conclusions According with our results, there is a MVP population (more than the half in our series) having a "paradoxical" Strain (stretching) in one of the basal inferior-to-lateral segments in mid-systole. The passive continuous stretching of myocardial cells is known to lead, with time, to the replacement with fibrosis (and fibrosis is a condition that is well known to be a source of arrhythmias, and even malignant). Cardiac Magnetic Resonance (CMR) already demonstrated the presence of fibrosis just in the same basal wall segments in some MVP patients. Thus, considering our results in the Strain, in MVP patients with ventricular arrhythmias it is mandatory to analyze the Strain (not expensive tool), and then, if the Strain were to be found to be "paradoxical" even in only one segment of this previously called "triad", a further evaluation with CMR (even if expensive) is highly recommended to look for the presence of fibrosis. The Strain is highly recommended because the topic is implicated in prognosis, in the further study of arrhythmias, and in the choice of a proper therapy as well. Fig 1 Fig 2
Published Version
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