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Electrocardiography and echocardiography in patients with chest pain and mitral leaflet prolapse
Insights
This study found that many patients with mitral leaflet prolapse (MLP) experience chest pain and normal coronary arteries. Echocardiography, particularly sector scans, is crucial for diagnosing MLP when physical exams are inconclusive.
Area of Science:
- Cardiology
- Diagnostic Imaging
Background:
- Mitral leaflet prolapse (MLP) can present with chest pain despite normal coronary arteries.
- Diagnosis of MLP can be challenging, especially in cases without clear auscultatory signs.
Purpose of the Study:
- To investigate the diagnostic utility of echocardiography in patients with catheter-verified, hemodynamically trivial mitral leaflet prolapse presenting with chest pain.
- To compare different echocardiographic views for detecting MLP.
Main Methods:
- Study included 34 patients with catheter-verified, hemodynamically trivial mitral leaflet prolapse and chest pain.
- Electrocardiogram (ECG) and exercise tests were performed.
- M-mode and sector-scan echocardiography were utilized, comparing apical 4-chamber and parasternal long-axis views.
Main Results:
- 29% of patients had infero-lateral repolarization changes on resting ECG.
- 50% of patients had false-positive exercise tests.
- Sector scans revealed MLP in 62% of patients, while M-mode echocardiography was less effective. The apical 4-chamber view was superior to the parasternal long-axis view.
Conclusions:
- Echocardiography, specifically sector scans and the apical 4-chamber view, is valuable for diagnosing mitral leaflet prolapse in patients with chest pain and normal coronary arteries.
- Physical examination and M-mode echocardiography may underestimate the prevalence of MLP in this patient group.
Abstract:
34 patients with catheter verified, haemodynamically trivial mitral leaflet prolapse with chest pain and normal coronary arteries were studied. Nineteen had no auscultatory signs of MLP despite clear catheter or echocardiographic evidence of prolapse. Infero-lateral repolarisation changes on the resting electrocardiogram were present in 29%. 50% had false positive exercise tests. M-mode echocardiography proved diagnostically disappointing but sector scans revealed mitral leaflet prolapse in 62%. The apical 4 chamber acoustic window was markedly superior to the parasternal long axis acoustic window.