Electromechanical activation and recovery wave imaging for pediatric mitral valve disease characterization
Melina Tourni, Christina Proestaki, Seungyeon Julia Han, Johanna B. Tonko, Mary Kucinski, Rachel Weber, Rosalia Minyety, Yaffa Wolicki, Youssef A. Elnabawi, Aikaterini Afentouli, Jad El Harake, Cagla Ozsoy, Hannah Schleifer, Leonardo Liberman, Alexandra Channing, Elisa E. Konofagou
Mitral valve (MV) disease, particularly MV prolapse (MVP) and mitral regurgitation (MR), affects 2 to 5% of the population and poses a substantial arrhythmogenic risk, with 43% of MVP patients developing arrhythmias. Although less common in children, the absence of comorbidities can uniquely isolate early electromechanical alterations that may elucidate mechanisms later contributing to arrhythmic risk and devastating effects such as sudden cardiac death. Conventional echocardiography lacks sensitivity for MV electromechanics, motivating advanced approaches. We introduce Electromechanical Wave Imaging (EWI), a high-frame-rate echocardiography modality, to map MV-complex activation and diastolic recovery in N = 21 MVP, MR, and control pediatric subjects (13.10 ± 4.51 y old, 43% male). A preclinical canine study (n = 3) established EWI’s ability to observe temporally coupled electromechanical wave propagation across the atrioventricular junction through the closed MV-following atrial and preceding ventricular activation (73.0 ms, 60 BPM). MVP patients exhibited significantly delayed left ventricular (LV) activation (76.04 ± 12.51 ms vs. 47.64 ± 2.57 ms in controls,