Valvular & structural heart disease
Bifid-E Wave: A Novel Doppler Marker of Advanced Mitral Prolapse and Disproportionate Left Ventricular Enlargement
Authors' conclusion
We identified a novel mitral Doppler sign that could represent an echocardiographic marker of advanced MVP with a large regurgitant volume and more myocardial fibrosis.
Study context
- Population
- Patients with mitral valve prolapse, bileaflet or single leaflet prolapse, assessed with cardiac magnetic resonance and transthoracic echocardiographydivided equally between bileaflet prolapse (BLP) and single leaflet prolapse (SLP)
- Participants
- 134 patients
- Exposure
- BLP vs SLP; bifid-E wave vs single-E wave
- Outcome
- Prolapse volume, total MR volume, and LV volume, BLP vs SLP
Main finding
As reported in the abstract
- Patients with BLP had a larger prolapse volume, total mitral regurgitation (MR) volume, and left ventricular (LV) volume compared to SLP
Observational data: associations, not effects.
Further findings
| Outcome | BLP | SLP |
|---|---|---|
| Prevalence of bifid-E wave | 33% | 6% |
BLP in bifid-E wave patients
- bifid-E wave patients were more likely to have BLP
Prolapse volume, total MR and LV volumes, disproportionate LV enlargement, bifid-E vs single-E wave
- Patients with bifid-E had a larger prolapse volume but similar total MR and LV volumes; however, disproportionate LV enlargement (enlarged LV with mild MR) was more prevalent in bifid-E wave patients
Parameters associated with the bifid-E wave (multivariable analysis)
- Parameters associated with the bifid-E were LV replacement fibrosis, prolapse volume, and disproportionate LV enlargement
Parameters associated with mitral valve prolapse (MVP)-related fibrosis
- The bifid-E wave was the sole parameter associated with MVP-related fibrosis
Original publication
Bifid-E Wave: A Novel Doppler Marker of Advanced Mitral Prolapse and Disproportionate Left Ventricular Enlargement. JACC Adv. Published 18 June 2025. doi:10.
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