Ultrasound reveals hidden electrical delays in diseased hearts

A standard echocardiogram shows a valve moving and blood being pumped. At Columbia Engineering, Elisa Konofagou’s team is adding another layer: a map of how electrical activation and mechanical motion travel through the heart. In a new study, that Electromechanical Wave Imaging (EWI) identified delayed activity in pediatric patients with mitral valve disease, including near the muscles that help close the valve.

The study included 21 pediatric subjects with healthy, MVP- or MR-affected hearts, plus two adults with arrhythmogenic MVP. Patients with MVP showed significantly delayed electromechanical activation of the left ventricle, particularly around the papillary muscles. Even mild MVP and MR were associated with longer full-heart activation and recovery times than in healthy subjects; MR patients had longer recovery times than those with MVP.

The mechanism matters because MVP and MR are not only structural problems. MVP makes the valve bend backward as the heart contracts, while MR prevents it from closing fully, allowing blood to leak backward. The team’s results indicate that these valve changes can coincide with altered timing in surrounding heart muscle—signals that conventional echocardiography does not directly map.

In the two adults with arrhythmogenic MVP, a single echocardiographic examination noninvasively co-located spontaneous abnormal heartbeats with regions of locally delayed electromechanical function. Preclinical studies supported the finding. The measurements came from a small clinical study, however, and the researchers plan to test EWI in a larger population before pursuing everyday use on clinical ultrasound scanners.

So what does this change in practice? If larger studies confirm the result, clinicians could use one noninvasive ultrasound examination to assess valve structure, heart mechanics and electrical timing together. That could help identify subtle abnormalities earlier and inform risk assessment for patients whose valve disease or arrhythmias are not fully explained by a conventional scan. For now, EWI remains an investigational technique rather than a routine diagnostic tool.