Papillary Muscle Free Strain in Patients with Severe Degenerative and Functional
            Mitral Regurgitation

Kılıçgedik, Alev; Kahveci, Gökhan; Gürbüz, Ahmet Seyfeddin; Karabay, Can Yücel; Güler, Ahmet; Efe, Süleyman Çağan; Aung, Soe Moe; Arslantaş, Uğur; Demir, Serdar; İzgi, İbrahim Akın; Kırma, Cevat

doi:10.5935/abc.20170035

Cited by 8 publications

(5 citation statements)

References 25 publications

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“…4. These computed temporal myofiber stretch evolutions are in line with clinical observations for non-diseased human hearts, measured with both ultrasound and magnetic resonance imaging techniques [54][55][56][57]. Naturally, the corresponding pressure-volume loops and cardiac output remain constant.…”

Section: Mechanical Drug Effectssupporting

confidence: 81%

How drugs modulate the performance of the human heart

et al. 2022

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Many drugs interact with ion channels in the cells of our heart and trigger heart rhythm disorders with potentially fatal consequences. Computational modeling can provide mechanistic insight into the onset and propagation of drug-induced arrhythmias, but the effect of drugs on the mechanical performance of the heart remains poorly understood. Here we establish a multiphysics framework that integrates the biochemical, electrical, and mechanical effects of drugs, from cellular excitation to cardiac contraction. For the example of the drug dofetilide, we show that drug concentrations of 5x and 8x increase the heart rate to 122 and 114 beats per minute, increase myofiber stretches by 5%, and decrease overall tissue relaxation by 6%. This results in inter-ventricular and atrial-ventricular dyssynchronies and changes in cardiac output by −2.5% and +7%. Our results emphasize the need for multiphysics modeling to better understand the mechanical implications of drug-induced arrhythmias. Knowing how different drug concentrations affect the performance of the heart has important clinical implications in drug safety evaluation and personalized medicine.

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Section: Mechanical Drug Effectssupporting

confidence: 81%

How drugs modulate the performance of the human heart

et al. 2022

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“…По данным исследования, деформация инфарцированных сегментов являлась предиктором ИМР при нижнезаднем ИМ, а диссинхрония ПМ -предиктором ИМР при ИМ обеих локализаций. Работы, изучающие деформацию ПМ и их диссинхронию, малочисленны [9,10], а исследования в раннем периоде ИМ отсутствуют. По нашим данным диссинхрония ПМ >30 мс прогнозирует ИМР.…”

Section: Discussionunclassified

Mechanisms and predictors of ischemic mitral regurgitation at rest and on exertion in patients at early stage of myocardial infarction

et al. 2020

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Aim. Determination of the mechanisms and predictors of ischemic mitral regurgitation (IMR) at rest and on exertion in patients at early stage of myocardial infarction (MI).Material and methods. Seventy-seven patients with inferoposterior MI and 79 patients with anteroseptal apical MI were examined on the 7th day at rest and after exertion. We determined the degree of IMR (according to the PISA method), posteromedial and anterolateral papillary muscle (PM) displacement, closure height of the mitral valve (MV), systolic and diastolic mitral valve orifice area, volume of the left ventricle (LV), LV contractility index, deformation of the infarction regions, general LV deformation, deformation and systolic dyssinchrony of the PM.Results. IMR was more common in inferior MI (42% vs 28%). LV volumes in cases with anteroseptal apical MI and IMR were greater and LV deformation was less than in patients without IMR. In inferoposterior MI and IMR, differences were observed in the index of local contractility and function of the posteromedial PM. The differences in MI of both localizations and IMR compared with MI without IMR were the areas of the mitral orifice and dyssinchrony of the PM. The degree of IMR after exertion did not depend on the degree of IMR at rest. Predictors of IMR at rest in MI of both localizations were the apical displacement of MV closure and the area of the mitral orifice. In inferoposterior, posteromedial PM displacement, deformation of the infarcted areas, PM dyssinchrony were also predictors. In anteroseptal apical MI, the area of the mitral orifice was the predictor of IMR. Predictors of anteroseptal apical MI after physical exertion after inferior MI were mitral orifice areas, contractility index, displacement and deformation of the posteromedial PM. In anteroseptal apical MI, the IMR predictors were MV closure height and systolic area of mitral orifice.Conclusion. The study confirms the significance of changing the spatial orientation of the MV structures in MI of both localizations, impaired regional contractility in inferoposterior MI and LV volume in anteroseptal apical MI at early stage of the disease.

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“…In a CMR study, Han et al described a higher excursion of the PMpm tip towards the mitral annular plane during systole in MVP patients compared with healthy volunteers; yet, did not compare it with the PMal (29). A more recent echocardiography study (30) found signi cantly lower longitudinal strain (i.e. less shortening) of the PMpm in MVP patients compared with controls (-30.5% vs. -43%), with no differences regarding the PMal, suggesting more pronounced mechanical stress of the posteromedial than the anterolateral PM.…”

Section: Detection Of Myocardial Brosismentioning

confidence: 99%

Left Ventricular Fibrosis and CMR Tissue Characterization of Papillary Muscles in Mitral Valve Prolapse Patients

Spampinato

Marín-Cuartas

Kampen

et al. 2023

Preprint

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Purpose. Mitral valve prolapse (MVP) is associated with left ventricle (LV) fibrosis, including the papillary muscles (PM), which is in turn linked to malignant arrhythmias. This study aims to evaluate comprehensive tissue characterization of the PM by cardiovascular magnetic resonance (CMR) imaging and its association with LV fibrosis observed by intraoperative biopsies. Methods. MVP patients with indication for surgery due to severe mitral regurgitation (n=19) underwent a preoperative CMR with characterization of the PM: dark-appearance on cine, T1 mapping, conventional bright blood (BB) and dark blood (DB) late gadolinium enhancement (LGE). CMR T1 mapping was performed on 21 healthy volunteers as controls. LV inferobasal myocardial biopsies were obtained in MVP patients and compared to CMR findings. Results. MVP patients (54±10 years old, 14 male) had a dark-appearance of the PM with higher native T1 and extracellular volume (ECV) values compared with healthy volunteers (1096±78ms vs 994±54ms and 33.9±5.6% vs 25.9±3.1%, respectively, p<0.001). Seventeen MVP patients (89.5%) had fibrosis by biopsy. BB-LGE+ in LV and PM was identified in 5 (26.3%) patients, while DB-LGE+ was observed in LV in 9 (47.4%) and in PM in 15 (78.9%) patients. DB-LGE+ in PM was the only technique that showed no difference with detection of LV fibrosis by biopsy. Posteromedial PM was more frequently affected than the anterolateral (73.7% vs 36.8%, p=0.039) and correlated with biopsy-proven LV fibrosis (Rho 0.529, p=0.029). Conclusions. CMR imaging in MVP patients referred for surgery shows a dark-appearance of the PM with higher T1 and ECV values compared with healthy volunteers. The presence of a positive DB-LGE at the posteromedial PM by CMR may serve as a better predictor of biopsy-proven LV inferobasal fibrosis than conventional CMR techniques.

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Papillary Muscle Free Strain in Patients with Severe Degenerative and Functional Mitral Regurgitation

Cited by 8 publications

References 25 publications

How drugs modulate the performance of the human heart

How drugs modulate the performance of the human heart

Mechanisms and predictors of ischemic mitral regurgitation at rest and on exertion in patients at early stage of myocardial infarction

Left Ventricular Fibrosis and CMR Tissue Characterization of Papillary Muscles in Mitral Valve Prolapse Patients

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