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A Simplified Stepwise Approach to Echo Guidance during Percutaneous Mitral Valve Repair
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Published on: October 16, 2021

Electromechanical activation and recovery wave imaging for pediatric mitral valve disease characterization

Melina Tourni1, Christina Proestaki1, Seungyeon Julia Han1

  • 1Department of Biomedical Engineering, Columbia University, New York, NY 10027.

Proceedings of the National Academy of Sciences of the United States of America
|August 17, 2026
PubMed

Insights

Electromechanical Wave Imaging (EWI) detects early electrical changes in pediatric mitral valve disease, identifying delayed activation and recovery linked to arrhythmia risk. This advanced echocardiography offers new insights into cardiac electromechanics.

Area of Science:

  • Cardiology
  • Biomedical Engineering
  • Medical Imaging

Background:

  • Mitral valve (MV) disease, including prolapse (MVP) and regurgitation (MR), affects 2-5% of the population and is linked to significant arrhythmogenic risk.
  • Pediatric MVP and MR can reveal early electromechanical alterations, crucial for understanding arrhythmia mechanisms and sudden cardiac death.
  • Conventional echocardiography has limited sensitivity for assessing MV electromechanics, necessitating advanced imaging techniques.

Purpose of the Study:

  • To introduce and validate Electromechanical Wave Imaging (EWI) for mapping MV-complex activation and diastolic recovery in pediatric subjects.
  • To investigate the electromechanical differences between pediatric patients with MVP/MR and healthy controls.
  • To assess EWI's potential for identifying arrhythmogenic substrates in MVP patients.

Main Methods:

  • EWI, a high-frame-rate echocardiography technique, was used to map electromechanical activity in 21 pediatric MVP, MR, and control subjects.
  • A preclinical canine study (n=3) established EWI's capability to track electromechanical wave propagation across the atrioventricular junction.
  • Analysis focused on left ventricular (LV) activation times and LV recovery intervals.

Main Results:

  • MVP patients showed significantly delayed LV activation (76.04 ± 12.51 ms) compared to controls (47.64 ± 2.57 ms), particularly in papillary muscles.
  • Both MVP and MR-only subjects exhibited prolonged LV recovery; MR-only patients had significantly longer recovery intervals (277.0 ± 27.61 ms) than controls (248.7 ± 10.43 ms).
  • In two arrhythmogenic MVP cases, EWI identified arrhythmic exit sites near LV papillary muscles, correlating with delayed sinus activation.

Conclusions:

  • Atrioventricular valve function significantly influences cardiac electromechanical function.
  • Full-cycle EWI is a transformative noninvasive tool for diagnosing MV disease electromechanical effects and assessing arrhythmia risk.
  • EWI can guide interventions and advance cardiac imaging for patients with mitral valve disease.

Keywords:
Electromechanical Wave Imagingcardiac activation and recoveryclinical echocardiographymitral valve diseasenoninvasive

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