An unusual pulsed-wave tissue Doppler pattern in mitral valve prolapse: spikes on systolic velocities

Mitral valve prolapse (MVP) can be associated with wall-motion abnormalities. Pulsed-wave Doppler tissue imaging (DTI) has been proposed as a method to obtain myocardial velocities with a high spatial and temporal resolution. Our aim was to investigate whether a specific DTI pattern exists in myocardial segments of patients with MVP.

We studied 49 consecutive patients with clinically suspected MVP. MVP was diagnosed in 35 patients. After recording the conventional echocardiographic variables, apical-directed left ventricular (LV) segmental myocardial velocities were obtained by DTI. The DTI analysis of myocardial segments revealed a distinct spectral Doppler pattern of mid- and basal posterior and lateral walls consistent with spikes on systolic velocities. These spikes were noticed in 23 (65%) patients with MVP but in none of the 14 subjects without MVP (P = 0.002). The MVP patients with spikes had larger mitral annulus diameters and higher amounts of maximal leaflet displacement when compared with those without spikes (34.8 +/- 5 mm vs 31.2 +/- 4 mm, P = 0.03 and 4.1 +/- 1 ms vs 3.1 +/- 1 mm, P = 0.01, respectively).

This newly described unique DTI pattern, which may be observed in the majority of patients with MVP, may contribute to the diagnosis of disease. However, future studies are required to evaluate the clinical significance and pathophysiology of the spikes on systolic velocities of posterior and lateral walls in patients with MVP.