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Diagnostics (Basel, Switzerland) Apr 2023: This study aimed to assess the value of radiomic features derived from the myocardium (MYO) and papillary muscle (PM) for left ventricular hypertrophy (LVH) detection...
: This study aimed to assess the value of radiomic features derived from the myocardium (MYO) and papillary muscle (PM) for left ventricular hypertrophy (LVH) detection and hypertrophic cardiomyopathy (HCM) versus hypertensive heart disease (HHD) differentiation. : There were 345 subjects who underwent cardiovascular magnetic resonance (CMR) examinations that were analyzed. After quality control and manual segmentation, the 3D radiomic features were extracted from the MYO and PM. The data were randomly split into training (70%) and testing (30%) datasets. Feature selection was performed on the training dataset. Five machine learning models were evaluated using the MYO, PM, and MYO+PM features in the detection and differentiation tasks. The optimal differentiation model was further evaluated using CMR parameters and combined features. : Six features were selected for the MYO, PM, and MYO+PM groups. The support vector machine models performed best in both the detection and differentiation tasks. For LVH detection, the highest area under the curve (AUC) was 0.966 in the MYO group. For HCM vs. HHD differentiation, the best AUC was 0.935 in the MYO+PM group. Comparing the radiomics models to the CMR parameter models for the differentiation tasks, the radiomics models achieved significantly improved the performance ( = 0.002). : The radiomics model with the MYO+PM features showed similar performance to the models developed from the MYO features in the detection task, but outperformed the models developed from the MYO or PM features in the differentiation task. In addition, the radiomic models performed better than the CMR parameters' models.
PubMed: 37174935
DOI: 10.3390/diagnostics13091544 -
European Radiology Jul 2023The prognostic role of left ventricular (LV) papillary muscle abnormalities in patients with preserved LV systolic ejection fraction (LVEF) is unknown. We sought to...
OBJECTIVES
The prognostic role of left ventricular (LV) papillary muscle abnormalities in patients with preserved LV systolic ejection fraction (LVEF) is unknown. We sought to evaluate the prognosis role of LV papillary muscle abnormalities by CMR in patients with ventricular arrhythmias, preserved LVEF with no cardiac disease.
METHODS
A total of 391 patients with > 500/24 h premature ventricular complexes and/or with non-sustained ventricular tachycardia (NSVT), preserved LVEF, and no cardiac disease were enrolled. Different features of LV papillary muscles were considered: supernumerary muscles, papillary thickness, the attachment, late gadolinium enhancement (LGE). Dark-Paps was defined as end-systolic signal hypointensity of both papillary muscles in early post-contrast cine CMR images. Mitral valve prolapse, mitral annular disjunction (MAD), and myocardial LGE were considered.
RESULTS
Dark-Paps was found in 79 (20%) patients and was more frequent in females. It was associated with higher prevalence of mitral valve prolapse and MAD. During a median follow-up of 2534 days, 22 hard cardiac events occurred. At Kaplan-Meier curve analysis, patients with Dark-Paps were at higher risk of events than those without (p < 0.0001). Dark-Paps was significantly associated with hard cardiac events in all the multivariate models. Dark-Paps improved prognostic estimation when added to NSVT (p = 0.0006), to LGE (p = 0.005) and to a model including NSVT+LGE (p = 0.014). Dark-Paps allowed a significant net reclassification when added to NSVT (NRI 0.30, p = 0.03), to LGE (NRI 0.25, p = 0.04), and to NSVT + LGE (NRI 0.32, p = 0.02).
CONCLUSIONS
In LV papillary muscles, Dark-Paps is a novel prognostic marker in patients with ventricular arrhythmias and preserved ejection fraction.
KEY POINTS
• Papillary muscle abnormalities are seen in patients with ventricular arrhythmias and preserved left ventricular ejection fraction. • Early post-contrast hypointensity of papillary muscles in end-systolic cine images (Dark-Paps) is a novel prognostic marker in patients with ventricular arrhythmias and preserved ejection fraction. • Dark-Paps had an additive prognostic role over late gadolinium enhancement and non-sustained ventricular tachycardia.
Topics: Female; Humans; Papillary Muscles; Contrast Media; Stroke Volume; Mitral Valve Prolapse; Prognosis; Ventricular Function, Left; Gadolinium; Magnetic Resonance Imaging, Cine; Arrhythmias, Cardiac; Heart Diseases; Tachycardia, Ventricular; Magnetic Resonance Spectroscopy; Predictive Value of Tests
PubMed: 36692598
DOI: 10.1007/s00330-023-09400-x -
JACC. Cardiovascular Interventions Sep 2019
Topics: Heart Rupture, Post-Infarction; Humans; Myocardial Infarction; Treatment Outcome
PubMed: 31537283
DOI: 10.1016/j.jcin.2019.06.010 -
Annals of Thoracic and Cardiovascular... Feb 2022Mitral subvalvular procedures in addition to restrictive annuloplasty are promising for ischemic mitral regurgitation (IMR). However, the prevalence and efficacy of...
OBJECTIVE
Mitral subvalvular procedures in addition to restrictive annuloplasty are promising for ischemic mitral regurgitation (IMR). However, the prevalence and efficacy of specific subvalvular repair in severe IMR have not been elucidated. This is the first nationwide survey regarding surgeons' attitudes toward IMR in Japan.
METHODS
A questionnaire was sent to 543 institutions. From 2015 to 2019, numbers of elective first-time mitral valve replacement (MVR) with/without complete chordal preservation (CCP)/papillary muscle approximation (PMA) and mitral valvuloplasty (MVP) with/without papillary muscle relocation (PMR)/PMA in patients with severe IMR were collected. Concomitant procedures for coronary artery, tricuspid valve, and arrhythmia could be included but left ventricular reconstruction was excluded.
RESULTS
Completed questionnaires were received from 286 institutions (52.7%). The majority (90%) had less than 20 cases within 5 years. The number of MVP (1413, 61.5%) surpassed MVR (886, 38.5%). CCP was performed in half of MVR (50.0%), while PMA was included in only 1.9% of MVR. PMA and PMR were also performed infrequently, in only 7.7% and 10.9% of MVP, respectively.
CONCLUSION
Japanese surgeons aggressively perform MVP for severe IMR. Subvalvular repair was also aggressively performed in addition to MVR, but not to MVP. A multicenter registry study is in progress.
Topics: Follow-Up Studies; Humans; Mitral Valve; Mitral Valve Annuloplasty; Mitral Valve Insufficiency; Surveys and Questionnaires; Treatment Outcome
PubMed: 34334538
DOI: 10.5761/atcs.oa.21-00048 -
Journal of Cardiac Surgery Dec 2022Mitral valve regurgitation (MR) is a common valvular disorder occurring in up to 10% of the general population. Mitral valve reconstructive strategies may address any of... (Review)
Review
Mitral valve regurgitation (MR) is a common valvular disorder occurring in up to 10% of the general population. Mitral valve reconstructive strategies may address any of the components, annulus, leaflets, and chords, involved in the valvular competence. The classical repair technique involves the resection of the prolapsing tissue. Chordal replacement was introduced already in the '60, but in the mid '80, some surgeons started to use expanded polytetrafluoroethylene (ePTFE) Gore-Tex sutures. In the last years, artificial chords have been used also using transcatheter approach such as NeoChord DS 1000 (Neochord) and Harpoon TSD-5. The first step is to achieve a good exposure of the papillary muscles that before approaching the implant of the artificial chords. Then, the chords are attached to the papillary muscle, with or without the use of supportive pledgets. The techniques to correctly implant artificial chords are many and might vary considerably from one center to another, but they can be summarized into three big families of suturing techniques: single, running or loop. Regardless of how to anchor to the mitral leaflet, the real challenge that many surgeons have taken on, giving rise to some very creative solutions, has been to establish an adequate length of the chords. It can be established based on anatomically healthy chords, but it is important to bear in mind that surgeons work on the mitral valve when the heart is arrested in diastole, so this length could fail to replicate the required length in the full, beating heart. Hence, some surgeons suggested techniques to overcome this problem. Herein, we aimed to describe the current use of artificial chords in real-world surgery, summarizing all the tips and tricks.
Topics: Humans; Mitral Valve; Chordae Tendineae; Mitral Valve Insufficiency; Cardiac Surgical Procedures; Prostheses and Implants; Polytetrafluoroethylene; Treatment Outcome
PubMed: 36321669
DOI: 10.1111/jocs.17076 -
Multimedia Manual of Cardiothoracic... Oct 2022We detail our technique for totally endoscopic, robotic-assisted mitral valve repair with the reimplantation of a ruptured papillary muscle head supported by double...
We detail our technique for totally endoscopic, robotic-assisted mitral valve repair with the reimplantation of a ruptured papillary muscle head supported by double papillary muscle relocation and mitral annuloplasty for the treatment of nonacute ischemic mitral regurgitation.
Topics: Humans; Papillary Muscles; Robotic Surgical Procedures; Mitral Valve Annuloplasty; Mitral Valve Insufficiency; Replantation
PubMed: 36314585
DOI: 10.1510/mmcts.2022.058 -
JACC. Cardiovascular Imaging Sep 2019
Topics: Cardiac Resynchronization Therapy; Heart Ventricles; Humans; Mitral Valve; Mitral Valve Insufficiency; Papillary Muscles
PubMed: 30660517
DOI: 10.1016/j.jcmg.2018.07.008 -
Insights Into Imaging Aug 2019Left ventricular papillary muscles are small myocardial structures that play an important role in the functioning of mitral valve and left ventricle. Typically, there... (Review)
Review
Left ventricular papillary muscles are small myocardial structures that play an important role in the functioning of mitral valve and left ventricle. Typically, there are two groups of papillary muscles, namely the anterolateral and the posteromedial groups. Cardiovascular magnetic resonance (CMR) is a valuable imaging modality in the evaluation of papillary muscles, providing both morphological and functional information. There is a remarkably wide variation in the morphology of papillary muscles. These variations can be asymptomatic or associated with symptoms related to LV outflow tract obstruction, often associated with hypertrophic cardiomyopathy. Abnormalities of the papillary muscles range from congenital disorders to neoplasms. Parachute mitral valve is the most common congenital abnormality of papillary muscles, in which all the chordae insert into a single papillary muscle. Papillary muscles can become dysfunctional, most commonly due to ischemia. Papillary muscle rupture is a major complication of acute myocardial infarction that results in mitral regurgitation and associated with high mortality rates. The most common papillary neoplasm is metastasis, but primary benign and malignant neoplasms can also be seen. In this article, we discuss the role of CMR in the evaluation of papillary muscle anatomy, function, and abnormalities.
PubMed: 31428880
DOI: 10.1186/s13244-019-0761-3