Regional strain patterns in patients with mitral valve prolapse

Q: What are the key findings of this study?

Mitral valve prolapse was associated with impaired regional longitudinal strain in basal left ventricular segments (e.g., +6.0 percentage points in the basal anterolateral segment) and increased strain in apical segments compared to healthy controls.

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Mitral valve prolapse (n=182). Intervention: Mitral valve prolapse vs. Healthy controls without cardiac condition. Primary outcome: Regional peak left ventricular longitudinal strain in the basal anterolateral segment (S6) (MD +6.0 percentage points, 95% CI 3.1-9.0).

Q: What does this research mean for the field?

Patients with mitral valve prolapse exhibit impaired left ventricular regional longitudinal strain in basal segments and increased strain in apical segments despite preserved global longitudinal and circumferential strain. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.NEUTRAL.

Jeffrey Ji-Peng Li; Shing Ching; Annette Aigner; Frank Edelmann; Stefanie Maria Werhahn; Rebecca Beyer; Jeanette Schulz-Menger; Jennifer Erley; Misael Estepa; Cyrill Meuwly; Ann-Sophie Eggers; Christian Stehning; Djawid Hashemi; Natalia Solowjowa; Christoph Klein; Ingo Hilgendorf; Sebastian Kelle; Patrick Doeblin

doi:10.1007/s00392-026-03033-y

October 7, 2026Clinical Research in CardiologyOpen Access

Regional strain patterns in patients with mitral valve prolapse

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Key result

Mitral valve prolapse linked to ~6-point worse basal LV longitudinal strain versus controls.

MD +6.0 percentage points
95% CI 3.1-9.0
n=182

Why the study?

Patients with mitral valve prolapse exhibit altered regional contraction patterns, but quantification using CMR feature tracking strain analysis compared to controls was lacking.

Does mitral valve prolapse alter regional myocardial strain patterns compared to healthy controls?

Key Points

To quantify left ventricular regional contraction patterns in patients with mitral valve prolapse compared to healthy controls using cardiovascular magnetic resonance feature tracking.
Retrospective single-center study comparing 132 patients with mitral valve prolapse to 50 healthy controls imaged between 2013 and 2022 on 1.5-T and 3-T scanners.
Cardiovascular magnetic resonance feature-tracking strain analysis was performed on cine images using MEDIS QStrain 4.1.
Primary endpoints were regional peak left ventricular longitudinal strain values, evaluated with multivariable linear regression adjusted for age and sex.
Adjusted regional longitudinal strain was significantly impaired (less negative) in basal segments, including the basal anterolateral (+6.0 pp, 95% CI 3.1 to 9.0), basal inferior (+3.5 pp, 95% CI 0.7 to 6.4), and basal anterior segments (+3.3 pp, 95% CI 0.7 to 5.8).
Compensatory increased strain (more negative) occurred in apical segments, including apical inferior (-5.4 pp, 95% CI -8.6 to -2.3), apical anterior (-4.9 pp, 95% CI -8.5 to -1.4), and apical lateral segments (-3.8 pp, 95% CI -6.9 to -0.8).
Global parameters were preserved, showing no significant difference in left ventricular global longitudinal strain (+0.5 pp, 95% CI -0.7 to +1.8) or global circumferential strain (+0.4 pp, 95% CI -1.3 to +2.3).

Study Design

Type

Observational (n=182)

Multicenter

No

Structured PICO

Does mitral valve prolapse alter regional myocardial strain patterns compared to healthy controls?

P

Population

182 adults (132 with mitral valve prolapse and 50 healthy controls) who underwent cardiac magnetic resonance imaging, excluding those with coronary heart disease or LVEF <50%.

E

Exposure

Presence of mitral valve prolapse (MVP) evaluated by cardiovascular magnetic resonance feature tracking (CMR-FT)

C

Comparator

Healthy controls without apparent heart disease evaluated by CMR-FT

O

Outcome

Regional peak left ventricular (LV) longitudinal strain valuessurrogate

Main Result

Mean Difference: 6 (95% CI 3.1–9)

Absolute Event Rate: -27.4% vs -33.4%

Patients with mitral valve prolapse exhibit a distinct regional contraction pattern characterized by impaired basal and increased apical longitudinal strain, despite having preserved global LV strain.

Limitations

Retrospective study design.
Differences in age and sex distribution between the patient and control groups.
Temporal resolution of CMR-FT may lead to underestimation of strain values for short-duration myocardial motions.
Transthoracic echocardiography images were available only for a small subset of patients.

Implication

Regional strain changes in mitral valve prolapse should not alter management; extends echocardiographic observations with CMR but leaves prognostic value open.

Abstract

Purpose Echocardiographic studies have shown that patients with mitral valve prolapse (MVP) exhibit altered regional contraction patterns. With cardiovascular magnetic resonance (CMR) becoming increasingly important in the evaluation of global and regional cardiac function, we aimed to quantify the regional contraction patterns of patients with MVP using CMR feature tracking (FT) strain analysis in comparison to a control group. Methods Of all patients who underwent CMR scans from 2013 to 2022 at our institution, 132 patients with MVP were identified and compared to 50 controls without any cardiac condition. CMR scans were performed on 1.5-T and 3-T scanners, and CMR-FT strain analysis was performed on cine images using MEDIS QStrain 4.1. The primary endpoints were regional peak left ventricular (LV) longitudinal strain values. Secondary endpoints included LV global circumferential strain (GCS) and global longitudinal strain (GLS) and left atrial (LA) reservoir strain and right ventricular (RV) free wall longitudinal strain. Differences between groups were assessed using linear regression models, adjusting for age and sex. Results Patients with MVP showed worse regional peak longitudinal strain compared to controls in the basal and part of the medial LV segments, especially in segments S1, S4, S6, S7, and S12. In contrast, the apical segments S13, S14, S15, and S16 showed better strain values. Additionally, LA reservoir strain was reduced in MVP patients. LV GCS, LV GLS, and RV free wall longitudinal strain were similar between both groups. Conclusion While patients with MVP showed preserved LV GCS and GLS compared to controls, LV regional longitudinal strain analysis showed impaired strain in the basal segments and increased strain in the apical segments.

Discussion

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Cite This Study

Li et al. (2026) conducted an observational in Mitral valve prolapse (n=182). Mitral valve prolapse vs. Healthy controls without cardiac condition was evaluated on Regional peak left ventricular longitudinal strain in the basal anterolateral segment (S6) (MD +6.0 percentage points, 95% CI 3.1-9.0). Mitral valve prolapse was associated with impaired regional longitudinal strain in basal left ventricular segments (e.g., +6.0 percentage points in the basal anterolateral segment) and increased strain in apical segments compared to healthy controls.

synapsesocial.com/papers/6ac835407c3139e1cb0e7de3 https://doi.org/10.1007/s00392-026-03033-y

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Regional strain patterns in patients with mitral valve prolapse

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Regional strain patterns in patients with mitral valve prolapse

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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