The potency of transthoracic echocardiography in assessing arrhythmogenic trigger and substrate: Novel risk markers for malignant mitral valve prolapse

Abstract

In the current issue of the IJC, Dorobantu et al. [ [1] Dorobantu D.M. Radulescu C.R. Riding N. et al. The use of 2-D speckle tracking echocardiography in assessing adolescent athletes with left ventricular hypertrabeculation meeting the criteria for left ventricular non-compaction cardiomyopathy. Int. J. Cardiol. 2023; 371: 500-507 Abstract Full Text Full Text PDF PubMed Scopus (0) Google Scholar ] highlighted the role of 2-D speckle-tracking echocardiography (STE) in characterizing cardiac function in the presence of hypertrabeculation, their study inspired us to investigate the potency of 2-D echocardiography in assessing mechanism of arrhythmia in malignant mitral valve prolapse (MVP). MVP is one of the most common valvular heart diseases, unless the coexistence of severe mitral regurgitation (MR), it has generally been considered in the past to be a benign disease. In recent years, several studies have showed that some patients with MVP are at high risk of life-threatening ventricular arrhythmias (VAs) and sudden cardiac death (SCD) [ [2] Malyshev Y. Borisov M. Shrestha S. et al. Hidden in plain sight: a case of arrhythmic mitral valve prolapse presenting as cardiac arrest. Cureus. 2021; Crossref Google Scholar , [3] Tong J. Yew M. Huang W. et al. The dance of death: cardiac arrest, mitral and tricuspid valve prolapses, and biannular disjunctions. CASE. 2022; 6: 95-102 Abstract Full Text Full Text PDF Google Scholar ]. This malignant phenotype of MVP characterized by bileaflet myxomatous prolapse, mitral annulus disjunction (MAD) and curling motion on echocardiogram [ [2] Malyshev Y. Borisov M. Shrestha S. et al. Hidden in plain sight: a case of arrhythmic mitral valve prolapse presenting as cardiac arrest. Cureus. 2021; Crossref Google Scholar , [3] Tong J. Yew M. Huang W. et al. The dance of death: cardiac arrest, mitral and tricuspid valve prolapses, and biannular disjunctions. CASE. 2022; 6: 95-102 Abstract Full Text Full Text PDF Google Scholar ].