Ultrasound Technique Enables Arrhythmia Risk Assessment in Mitral Valve Disease

Sudden cardiac death can occur when dangerous arrhythmias go undetected. Mitral valve prolapse and mitral regurgitation affect an estimated 2–5% of the population and have been linked to such events as disease advances. Arrhythmogenic mitral valve disease refers to cases in which progression has already resulted in ventricular arrhythmias. To help address this risk, researchers have developed a cardiac ultrasound technique that reveals hidden electromechanical abnormalities associated with these valve disorders.

Electromechanical Wave Imaging (EWI), developed at Columbia Engineering, maps the heart’s electrical activation and mechanical response from standard echocardiograms. The technique extends conventional ultrasound by visualizing how electromechanical activity propagates through the myocardium over time. It is designed to make otherwise invisible abnormalities visible to clinicians.

In a study published in PNAS on August 17, 2026, investigators from Columbia Engineering, Columbia NYP Pediatric Cardiology, and the Institute of Cardiovascular Sciences at University College London examined EWI in pediatric mitral valve disease. The study observed 21 pediatric subjects spanning healthy hearts and those affected by mitral valve prolapse or mitral regurgitation. Patients with prolapse showed significantly delayed left ventricular electromechanical activation, particularly near the papillary muscles responsible for valve closure.

Across the cohort, even mild forms of prolapse and regurgitation were associated with longer total electromechanical activation and recovery times than in healthy peers, with regurgitation producing longer recovery than prolapse. Two adults with arrhythmogenic mitral valve prolapse were also imaged. In these adults, a single echocardiographic examination identified and co-localized spontaneous arrhythmia sources with regions of locally delayed electromechanical function noninvasively, findings that were corroborated by preclinical studies.

Validation indicates that EWI can provide diagnostic information beyond a standard echocardiogram by assessing the heart as an integrated electrical, mechanical, and valvular system. This added layer may help clinicians recognize subtle dysfunction not readily apparent on conventional ultrasound, magnetic resonance imaging (MRI), computed tomography (CT), or positron emission tomography (PET). The team plans to expand testing to larger populations and to integrate the method into clinical ultrasound scanners for routine point-of-care use.

“Our work has provided a new way to dive deeper into the important role that proper function of the mitral valve dictates how valve diseases affect the overall cardiac function and activation,” said Elisa Konofagou, the Robert and Margaret Hariri Professor of Biomedical Engineering at Columbia Engineering.

“By using EWI to both detect and visualize these changes that are otherwise invisible by current clinical modalities, we hope to confirm it could be used for early detection and risk assessment, transforming how we evaluate and improve care for those suffering from mitral valve disease, but also arrhythmias in general,” added Konofagou.

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