El-Tallawi K Carlos, Qamar Fatima, Zoghbi William A, Shah Dipan J
Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA.
Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA.
JACC Adv. 2025 Jul;4(7):101881. doi: 10.1016/j.jacadv.2025.101881. Epub 2025 Jun 18.
Mitral valve prolapse (MVP) is a relatively common valvular disease initially assessed using transthoracic echocardiography. We identified a novel mitral inflow Doppler signal-bifid-E wave-in patients with MVP.
The authors postulated that the bifid-E wave is predominantly present in bileaflet prolapse (BLP), representing the displaced prolapse volume in early diastole. We investigated this further to identify its determinants and associated parameters using cardiac magnetic resonance imaging.
This is a cross-sectional study where we analyzed 134 patients divided equally between BLP and single leaflet prolapse (SLP). Cardiac magnetic resonance was used to assess chamber volumes, mitral regurgitation (MR), and prolapse volume. Transthoracic echocardiography was used to determine single vs bifid-E wave morphology. Multivariable analysis was performed to identify the parameters associated with the bifid-E wave.
Patients with BLP had a larger prolapse volume, total MR volume, and left ventricular (LV) volume compared to SLP. Bifid-E wave was more prevalent in BLP vs SLP (33% vs 6%). Additionally, bifid-E wave patients were more likely to have BLP. When compared to single-E wave, patients with bifid-E had a larger prolapse volume but similar total MR and LV volumes; however, disproportionate LV enlargement (enlarged LV with mild MR) was more prevalent in bifid-E wave patients. On multivariable analysis, parameters associated with the bifid-E were LV replacement fibrosis, prolapse volume, and disproportionate LV enlargement. Finally, the bifid-E wave was the sole parameter associated with MVP-related fibrosis.
We identified a novel mitral Doppler sign that could represent an echocardiographic marker of advanced MVP with a large regurgitant volume and more myocardial fibrosis.
二尖瓣脱垂（MVP）是一种相对常见的瓣膜疾病，最初通过经胸超声心动图进行评估。我们在MVP患者中发现了一种新的二尖瓣流入多普勒信号——双峰E波。
作者推测双峰E波主要出现在双叶脱垂（BLP）中，代表舒张早期脱垂的移位容积。我们进一步研究以使用心脏磁共振成像确定其决定因素和相关参数。
这是一项横断面研究，我们分析了134例患者，BLP组和单叶脱垂（SLP）组各占一半。使用心脏磁共振评估心室容积、二尖瓣反流（MR）和脱垂容积。经胸超声心动图用于确定单峰与双峰E波形态。进行多变量分析以确定与双峰E波相关的参数。
与SLP相比，BLP患者的脱垂容积、总MR容积和左心室（LV）容积更大。双峰E波在BLP中比SLP中更常见（33%对6%）。此外，双峰E波患者更可能患有BLP。与单峰E波相比，双峰E波患者的脱垂容积更大，但总MR和LV容积相似；然而，不成比例的LV扩大（轻度MR伴LV扩大）在双峰E波患者中更常见。在多变量分析中，与双峰E波相关的参数是LV替代纤维化、脱垂容积和不成比例的LV扩大。最后，双峰E波是与MVP相关纤维化相关的唯一参数。
我们发现了一种新的二尖瓣多普勒征象，它可能代表具有大量反流容积和更多心肌纤维化的晚期MVP的超声心动图标志物。
