Papillary Muscle Dysfunction Attenuates Ischemic Mitral Regurgitation in Patients With Localized Basal Inferior Left Ventricular Remodeling

Uemura, T.; Nakashiki, Kennichi

doi:10.1016/j.accreview.2005.11.031

Cited by 13 publications

(16 citation statements)

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“…Those latter observations are best explained by what we refer to as the "tethering theory." Though IMR is a complex entity and a role for restricted leaflet motion, [22][23][24] annular dilatation, 25 papillary muscle (PM) dysfunction, 26 and many other alterations [27][28][29][30][31] have been postulated by different authors, we do agree with Levine and Schwammenthal. 27 that level of leaflet coaptation, then the possibility of MR, is finally determined by "tethering distance," which is defined as the distance between the PM and the mitral annulus; and its value here is the resultant of two ischemic changes: the altered bearing point of the PM base, and the altered length of the PM.…”

Section: Discussionsupporting

confidence: 81%

Novel Echocardiographic Indices as Predictors of Immediate Recurrence after Undersized Ring Annuloplasty for Ischemic Mitral Regurgitation

et al. 2015

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Background and aim: Ischemic mitral regurgitation (IMR) is among the most serious complications of myocardial infarction which doubles the late mortality; mainly treated by undersizing ring annuloplasty. To find some preoperative echocardiographic indices that predict immediate failure of mitral valve annuloplasty (MVA), we designed the present study with more focusing on some novel parameters. Method: Transthoracic echocardiography (TTE) indices of consecutive patients referred with 3+ or 4+ IMR were registered 24 hours before surgery. Thirty days later, a second TTE was performed. According to the results, the patients were categorized as the "successful" group (with 1+ or less mitral regurgitation) and the "unsuccessful" group (with 2+ or higher MR). Preoperative TTE indices were compared among the two groups using suitable statistical tests. Results: Of the total of 126 cases, 68 had successful and 58 had unsuccessful MVA. Statistically significant differences were found between the two groups for left ventricular ejection fraction (LVEF) (P = 0.007), left ventricular end systolic volume (LVESV) (P = 0.044), and basal-interpapillary muscle distance (IPMD) diastolic-to-systolic ratio (DSR) (P = 0.008). Receiver Operating Characteristic analysis demonstrated 37.5%, 3.85 cm 3 , and 1.25, as the best cutoff points for LVEF (P = 0.03, sensitivity: 81%, specificity: 69%), LVESV (P = 0.023, sensitivity: 83%, specificity: 57%), and basal-IPMD DSR (P = 0.001, sensitivity: 100%, specificity: 95%), respectively. Conclusion: Among all TTE indices, LVEF, LVESV, and basal-IPMD DSR were helpful to differentiate between the successful and unsuccessful MVA results. We believe the basal-IPMD DSR as a novel index could be targeted in the future studies. (Echocardiography 2015;32:1339-1346

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Section: Discussionsupporting

confidence: 81%

Novel Echocardiographic Indices as Predictors of Immediate Recurrence after Undersized Ring Annuloplasty for Ischemic Mitral Regurgitation

et al. 2015

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“…Mitral valve insufficiency may be due to damage to the papillary apparatus in patients with IHD as well as due to dilatation of the mitral annulus, and this could account for differences in response. 23 However, as improvement in mitral regurgitation may be critically dependent on the site and timing of the ventricular stimuli, the aetiology of heart failure may not be an overriding factor in clinical practice, as suggested by this study. 24 – 28 …”

Section: Discussionmentioning

confidence: 59%

The effects of aetiology on outcome in patients treated with cardiac resynchronization therapy in the CARE-HF trial

Wikström

Blomström‐Lundqvist

Andrén

et al. 2008

European Heart Journal

145

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AimsCardiac dyssynchrony is common in patients with heart failure, whether or not they have ischaemic heart disease (IHD). The effect of the underlying cause of cardiac dysfunction on the response to cardiac resynchronization therapy (CRT) is unknown. This issue was addressed using data from the CARE-HF trial.Methods and resultsPatients (n = 813) were grouped by heart failure aetiology (IHD n = 339 vs. non-IHD n = 473), and the primary composite (all-cause mortality or unplanned hospitalization for a major cardiovascular event) and principal secondary (all-cause mortality) endpoints analysed. Heart failure severity and the degree of dyssynchrony were compared between the groups by analysing baseline clinical and echocardiographic variables. Patients with IHD were more likely to be in NYHA class IV (7.5 vs. 4.0%; P = 0.03) and to have higher NT-proBNP levels (2182 vs. 1725 pg/L), indicating more advanced heart failure. The degree of dyssynchrony was more pronounced in patients without IHD (assessed using mean QRS duration, interventricular mechanical delay, and aorta-pulmonary pre-ejection time). Left ventricular ejection fraction and left ventricular end-systolic volume improved to a lesser extent in the IHD group (4.53 vs. 8.50% and −35.68 vs. –58.52 cm3). Despite these differences, CRT improved all-cause mortality, NYHA class, and hospitalization rates to a similar extent in patients with or without IHD.ConclusionThe benefits of CRT in patients with or without IHD were similar in relative terms in the CARE-HF study but as patients with IHD had a worse prognosis, the benefit in absolute terms may be greater.

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“…Messas et al [23] in animals, using 3D echocardiography and Uemura et al [24] in humans using transthoracic echocardiography demonstrated that the severity of ischemic MR is primarily related to papillary muscle tethering distance and does not have any consistent relationship with papillary muscle dysfunction itself. In fact it has been shown that PM dysfunction per se, is associated with systolic elongation or less systolic shortening and paradoxically may result in attenuation of leaflet tethering and ischemic MR.…”

Section: Discussionmentioning

confidence: 99%

Papillary Muscle Function Does Not Predict Mitral Regurgitation in Patients with Normal Left Ventricular Systolic Function: A Transesophageal Echocardiographic Study

Madu¹,

Baugh²,

Tulloch-Reid³

et al. 2011

IJCM

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Objective: To evaluate LV papillary muscles (PM) function using transesophageal echocardiography (TEE), and to determine the relationship between PM function and mitral regurgitation in patients with normal left ventricular sys-tolic function. Design: TEE examinations were prospectively performed. End diastolic and end systolic PM lengths were obtained from the transgastric long axis views and fractional systolic shortening (FS) was calculated. LV ejection fraction was determined using modified Simpson rule and mitral regurgitation was determined using regurgitant jet area by color flow. Setting: Tertiary Center. Patients: 85 consecutive adult patients (51 with mitral regurgitation and 34 without) with normal LV chamber dimensions and LV systolic function, meeting enrollment criteria. Results: The % FS in patients with mitral regurgitation was 21.7 ± 3.6% for anterior PM (APM) and 18.7 ± 4.6% for posterior PM (PPM). In those without mitral regurgitation, the values were as follows; 22.6 ± 5.4% (APM) and 19.5 ± 3.8% (PPM). In a subgroup of patients with severe mitral regurgitation (n = 23), the values for PM FS were 20.3 ± 6.8 (APM) and 18.4 ± 6.9 % (PPM). There was no statistically significant difference in PM fractional shortening between the groups. Anterior papillary muscle length was longer in those patients with mitral regurgitation compared to those without [(End-diastolic length (cm): 3.38 ± 0.61 v 2.88 ± 0.47(p: 0.008) and end-systolic length of 2.46 ± 0.51 v 2.17 ± 0.33 (p: 0.04)]. These differences are more pronounced in those with severe mitral regurgitation (p: 0.002 and 0.004 for EDL and ESL respectively. Conclusion: In patients with normal LVEF, PM contraction is similar in those with and without MR. In patients with MR however, anterior PM length (ED & ES) is significantly increased. Our data suggests that in patients with normal LVEF, PM dysfunction appears to play no significant role in the causation of MR. Anterior papillary muscle length however, appears to be a major determinant of mitral regurgitation in such patients

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Papillary Muscle Dysfunction Attenuates Ischemic Mitral Regurgitation in Patients With Localized Basal Inferior Left Ventricular Remodeling

Cited by 13 publications

References 0 publications

Novel Echocardiographic Indices as Predictors of Immediate Recurrence after Undersized Ring Annuloplasty for Ischemic Mitral Regurgitation

Novel Echocardiographic Indices as Predictors of Immediate Recurrence after Undersized Ring Annuloplasty for Ischemic Mitral Regurgitation

The effects of aetiology on outcome in patients treated with cardiac resynchronization therapy in the CARE-HF trial

Papillary Muscle Function Does Not Predict Mitral Regurgitation in Patients with Normal Left Ventricular Systolic Function: A Transesophageal Echocardiographic Study

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