Fig. 2.

Echocardiographic biomarkers of arrhythmic MVP in a 35-year-old woman with MVP, moderate mitral regurgitation, and frequent premature ventricular contractions. A MAD. The yellow arrow shows the distance between the basal ventricular myocardium and the hinge point of the posterior leaflet in late systole. Bulging of the basal inferior-lateral myocardium, typical of the systolic curling, was also present in this patient. B Pickelhaube sign. A spiked late systolic high-velocity (21 cm/s) signal is recorded at the level of the lateral mitral annulus in a four-chamber view. C Speckle tracking imaging. Late post-systolic shortening (after aortic valve closure) of the basal inferior-lateral left ventricular wall (white arrow, green line). D Mechanical dispersion. Prolonged time-to-peak longitudinal strain is observed at the basal inferior, inferior-septal, and inferior-lateral walls and is related to myocardial periannular fibrosis