The implication of left ventricular mechanical dispersion as a risk predictor for ventricular arrhythmias in patients with mitral valve prolapse

Abstract

Background: Mitral valve prolapse (MVP) is considered a benign disorder, although it can be accompanied by ventricular arrhythmias (VA). Speckle tracking echocardiography (STE) can be a promising tool for detecting early derangement. Objectives: The aim of this study was to determine whether the left ventricular (LV) mechanical dispersion (MD) derived by STE can be considered a predictor for occurrence of VA in patients with MVP. Materials and Methods: This was a cross-sectional study conducted on 63 patients with MVP (37 women and 29 men) presented with palpitation. The patients were divided into two groups: arrhythmic patients with VA (Group 1) and non-arrhythmic patients (Group 2). All of them underwent comprehensive clinical and electrocardiographic examination, cardiac rhythm assessment by Holter monitoring, and comprehensive echocardiographic evaluation including speckle tracking technique. Results: VA were detected in 32 of 63 patients. Ventricular bigeminy was the most common type of VA in arrhythmic patients. Unlike other echocardiographic parameters, the LV MD and the mitral annular disjunction (MAD) were found to be significantly higher in arrhythmic versus non-arrhythmic MVP patients (P < 0.001). Furthermore, the mean LV MD was higher in patients with frequent ventricular ectopics versus infrequent ones (P = 0.003). The cutoff value for LV MD was 35.1 ms or higher (sensitivity 87%, specificity 71%) and for MAD it was 2.7 mm or higher (sensitivity 82%, specificity 60%) in predicting VA in patients with MVP. Conclusions: LV MD in addition to MAD can be implemented in risk prediction for VA in patients with MVP presenting with palpitations.

Keywords

• mechanical dispersion
• mitral valve prolapse
• speckle tracking echocardiography
• ventricular arrhythmia