Regional strain patterns in patients with mitral valve prolapse

Abstract Purpose Echocardiographic studies have shown that patients with mitral valve prolapse (MVP) exhibit altered regional contraction patterns. With cardiovascular magnetic resonance (CMR) becoming increasingly important in the evaluation of global and regional cardiac function, we aimed to quantify the regional contraction patterns of patients with MVP using CMR feature tracking (FT) strain analysis in comparison to a control group. Methods Of all patients who underwent CMR scans from 2013 to 2022 at our institution, 132 patients with MVP were identified and compared to 50 controls without any cardiac condition. CMR scans were performed on 1.5-T and 3-T scanners, and CMR-FT strain analysis was performed on cine images using MEDIS QStrain 4.1. The primary endpoints were regional peak left ventricular (LV) longitudinal strain values. Secondary endpoints included LV global circumferential strain (GCS) and global longitudinal strain (GLS) and left atrial (LA) reservoir strain and right ventricular (RV) free wall longitudinal strain. Differences between groups were assessed using linear regression models, adjusting for age and sex. Results Patients with MVP showed worse regional peak longitudinal strain compared to controls in the basal and part of the medial LV segments, especially in segments S1, S4, S6, S7, and S12. In contrast, the apical segments S13, S14, S15, and S16 showed better strain values. Additionally, LA reservoir strain was reduced in MVP patients. LV GCS, LV GLS, and RV free wall longitudinal strain were similar between both groups. Conclusion While patients with MVP showed preserved LV GCS and GLS compared to controls, LV regional longitudinal strain analysis showed impaired strain in the basal segments and increased strain in the apical segments.