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Journal of the American College of... Oct 2018Mitral annulus disjunction (MAD) is an abnormal atrial displacement of the mitral valve leaflet hinge point. MAD has been associated with mitral valve prolapse (MVP) and...
BACKGROUND
Mitral annulus disjunction (MAD) is an abnormal atrial displacement of the mitral valve leaflet hinge point. MAD has been associated with mitral valve prolapse (MVP) and sudden cardiac death.
OBJECTIVES
The purpose of this study was to describe the clinical presentation, MAD morphology, association with MVP, and ventricular arrhythmias in patients with MAD.
METHODS
The authors clinically examined patients with MAD. By echocardiography, the authors assessed the presence of MVP and measured MAD distance in parasternal long axis. Using cardiac magnetic resonance (CMR), the authors assessed circumferential MAD in the annular plane, longitudinal MAD distance, and myocardial fibrosis. Aborted cardiac arrest and sustained ventricular tachycardia were defined as severe arrhythmic events.
RESULTS
The authors included 116 patients with MAD (age 49 ± 15 years; 60% female). Palpitations were the most common symptom (71%). Severe arrhythmic events occurred in 14 (12%) patients. Longitudinal MAD distance measured by CMR was 3.0 mm (interquartile range [IQR]: 0 to 7.0 mm) and circumferential MAD was 150° (IQR: 90° to 210°). Patients with severe arrhythmic events were younger (age 37 ± 13 years vs. 51 ± 14 years; p = 0.001), had lower ejection fraction (51 ± 5% vs. 57 ± 7%; p = 0.002) and had more frequently papillary muscle fibrosis (4 [36%] vs. 6 [9%]; p = 0.03). MVP was evident in 90 (78%) patients and was not associated with ventricular arrhythmia.
CONCLUSIONS
Ventricular arrhythmias were frequent in patients with MAD. A total of 26 (22%) patients with MAD did not have MVP, and MVP was not associated with arrhythmic events, indicating MAD itself as an arrhythmogenic entity. MAD was detected around a large part of the mitral annulus circumference and was interspersed with normal tissue.
Topics: Adult; Arrhythmias, Cardiac; Cross-Sectional Studies; Death, Sudden, Cardiac; Echocardiography; Female; Fibrosis; Heart Arrest; Humans; Magnetic Resonance Imaging, Cine; Male; Middle Aged; Mitral Valve; Mitral Valve Insufficiency; Mitral Valve Prolapse; Papillary Muscles; Syndrome; Ventricular Premature Complexes
PubMed: 30261961
DOI: 10.1016/j.jacc.2018.07.070 -
Cardiovascular Journal of AfricaWe aimed to evaluate and compare papillary muscle free strain in hypertrophic cardiomyopathy (HCMP) and hypertensive (HT) patients.
OBJECTIVES
We aimed to evaluate and compare papillary muscle free strain in hypertrophic cardiomyopathy (HCMP) and hypertensive (HT) patients.
METHODS
Global longitudinal strain (GLS), and longitudinal myocardial strain of the anterolateral (ALPM) and posteromedial papillary muscles (PMPM) were obtained in 46 HCMP and 50 HT patients.
RESULTS
Interventricular septum (IVS)/posterior wall (PW) thickness ratio, left ventricular mass index (LVMI), left atrial anteroposterior diameter (LAAP) and mitral E/E' were found to be increased in patients with HCMP compared to HT patients. Left ventricular cavity dimensions were smaller in HCMP patients. GLS of HCMP and HT patients were - 14.52 ± 3.01 and -16.85 ± 1.36%, respectively ( < 0.001). Likewise, ALPM and PMPM free strain values were significantly reduced in HCMP patients over HT patients [-14.00% (-22 to -11%) and -15.5% (-24.02 to -10.16%) vs -23.00% (-24.99 to -19.01%) and -22.30% (-26.48 to -15.95%) ( = 0.016 and = 0.010)], respectively. ALPM free strain showed a statistically significant correlation with GLS, maximal wall thickness, IVS thickness and LVMI. PMPM free strain showed a significant correlation with GLS, IVS thickness and LAAP. The GLS value of - 13.05 had a sensitivity of 61.9% and a specificity of 97.4% for predicting HCMP. ALPM and PMPM free strain values of -15.31 and -17.17% had 63 and 76.9% sensitivity and 85.7 and 76.9% specificity for prediction of HCMP.
CONCLUSIONS
Besides other echocardiographic variables, which were investigated in earlier studies, papillary muscle free strain also could be used in HCMP to distinguish HCMP- from HT-associated hypertrophy.
Topics: Humans; Hypertrophy, Left Ventricular; Papillary Muscles; Myocardial Contraction; Cardiomyopathy, Hypertrophic; Hypertension; Ventricular Function, Left
PubMed: 36947167
DOI: 10.5830/CVJA-2022-070 -
Arquivos Brasileiros de Cardiologia Apr 2017The role of papillary muscle function in severe mitral regurgitation with preserved and reduced left ventricular ejection fraction and the method of choice to evaluate...
FUNDAMENTO:
The role of papillary muscle function in severe mitral regurgitation with preserved and reduced left ventricular ejection fraction and the method of choice to evaluate PM have still been the subjects of controversy.
OBJECTIVES:
To evaluate and compare papillary muscle function in and between patients with severe degenerative and functional mitral regurgitation by using the free strain method.
METHODS:
64 patients with severe mitral regurgitation - 39 patients with degenerative mitral regurgitation (DMR group) and 25 patients with severe functional mitral regurgitation (FMR group) - and 30 control subjects (control group) were included in the study. Papillary muscle function was evaluated through the free strain method from apical four chamber images of the anterolateral papillary muscle (APM) and from apical three chamber images of the posteromedial papillary muscle (PPM). Global left ventricular longitudinal and circumferential strains were evaluated by applying 2D speckle tracking imaging.
RESULTS:
Global left ventricular longitudinal strain (DMR group, -17 [-14.2/-20]; FMR group, -9 [-7/-10.7]; control group, -20 [-18/-21] p < 0.001), global left ventricular circumferential strain (DMR group, -20 [-14.5/-22.7]; FMR group, -10 [-7/-12]; control group, -23 [-21/-27.5] p < 0.001) and papillary musle strains (PPMS; DMR group, -30.5 [-24/-46.7]; FMR group, -18 [-12/-30]; control group; -43 [-34.5/-39.5] p < 0.001; APMS; DMR group, (-35 [-23.5/-43]; FMR group, -20 [-13.5/-26]; control group, -40 [-32.5/-48] p < 0.001) were significantly different among all groups. APMS and PPMS were highly correlated with LVEF (p < 0.001, p < 0.001; respectively), GLS (p < 0.001, p < 0.001; respectively) and GCS (p < 0.001, p < 0.00; respectively) of LV among all groups. No correlation was found between papillary muscle strains and effective orifice area (EOA) in both groups of severe mitral regurgitation.
CONCLUSIONS:
Measuring papillary muscle longitudinal strain by the free strain method is practical and applicable. Papillary muscle dysfunction plays a small role in severe MR due to degenerative or functional causes and papillary muscle functions in general seems to follow left ventricular function. PPM is the most affected PM in severe mitral regurgitation in both groups of DMR and FMR.
FUNDAMENTO:
O papel da função do músculo papilar na regurgitação mitral grave com fração de ejeção do ventrículo esquerdo preservada e reduzida e o método de escolha para avaliar PM ainda são objetos de controvérsia.
OBJETIVOS:
Avaliar e comparar a função dos músculos papilares entre pacientes com insuficiência mitral funcional e degenerativa pelo método free strain.
MÉTODOS:
64 pacientes com insuficiência mitral grave - 39 pacientes com insuficiência mitral degenerativa grave (grupo IMD) e 25 com insuficiência mitral funcional grave (grupo IMF) - e 30 indivíduos controle (grupo controle) foram incluídos no estudo. A função dos músculos papilares foi avaliada pelo método free strain a partir de imagens apicais quatro-câmaras do músculo papilar anterolateral (MPA) e imagens apicais três-câmaras do músculo papilar posteromedial (MPP). Strains circunferenciais e longitudinais globais do ventrículo esquerdo foram avaliados por meio de imagens bidimensionais a partir do rastreamento de conjunto de pontos de cinza (speckle tracking).
RESULTADOS:
O strain longitudinal global do ventrículo esquerdo (grupo IMD, -17 [-14,2/-20]; grupo IMF, -9 [-7/-10,7]; grupo controle, -20 [-18/-21] p < 0,001); strain circunferencial global do ventrículo esquerdo (grupo IMD, -20 [-14,5/-22,7]; grupo IMF, -10 [-7/-12]; grupo controle, -23 [-21/-27,5] p < 0,001) e strains de músculos papilares (MPP; grupo IMD, -30,5 [-24/-46,7]; grupo IMF, -18 [-12/-30]; grupo controle; -43 [-34,5/-39,5] p < 0,001; MPA; grupo IMD, (-35 [-23,5/-43]; grupo IMF, -20 [-13,5/-26]; grupo controle, -40 [-32,5/-48] p < 0,001) mostraram-se significativamente diferentes nos grupos. MPA e MPP mostraram-se altamente correlacionados com a FEVE (p < 0,001, p < 0,00; respectivamente), SLG (p < 0,001, p < 0,001; respectivamente) e SCG (p < 0,001, p < 0,001; respectivamente) do VE entre todos os grupos. Não foi encontrada correlação entre os strains de músculos papilares e área eficaz do orifício (AEO) nos grupos de insuficiência mitral grave.
CONCLUSÕES:
A medição do strain longitudinal de músculos papilares pelo método free strain é prática e aplicável. A disfunção dos músculos papilares tem um papel pequeno em IM grave devido a causas degenerativas e funcionais, e a função dos músculos papilares, em general, parece seguir a função ventricular esquerda. O MPP é o MP mais afetado na insuficiência mitral em ambos os grupos, IMD e IMF.
Topics: Adult; Aged; Echocardiography; Female; Humans; Male; Middle Aged; Mitral Valve Insufficiency; Papillary Muscles; Prospective Studies; Stroke Volume; Ventricular Function, Left
PubMed: 28538762
DOI: 10.5935/abc.20170035 -
Annals of Cardiac Anaesthesia 2021An asymptomatic 30-year-old male was referred for a transthoracic echocardiogram because of a systolic murmur that was noted on a pre-employment physical exam....
An asymptomatic 30-year-old male was referred for a transthoracic echocardiogram because of a systolic murmur that was noted on a pre-employment physical exam. Transthoracic imaging demonstrated a single papillary muscle from which the chordae of both mitral valve leaflets were attached. The mitral valve was seen to have a parachute-like configuration. Given the benign nature of the presentation, the patient did not seek further investigation.
Topics: Adult; Diagnostic Tests, Routine; Echocardiography; Humans; Male; Mitral Valve; Mitral Valve Insufficiency; Papillary Muscles; Referral and Consultation
PubMed: 33938836
DOI: 10.4103/aca.ACA_82_19 -
Romanian Journal of Internal Medicine =... Dec 2022We studied by means of echocardiography and cardiac MRI (CMR) the occurrence of an accessory papillary muscle that unites mostly the left ventricle (LV) apex with the...
We studied by means of echocardiography and cardiac MRI (CMR) the occurrence of an accessory papillary muscle that unites mostly the left ventricle (LV) apex with the basal antero-septum in the immediate vicinity of left ventricle outflow tract (LVOT) in patients with and without hypertrophic cardiomyopathy (HOCM). . We included all good quality echocardiography and CMR studies as reviewed by two cardiologists and assessed the occurrence of a contractile papillary muscle situated between the LV apex and antero-septum. A contractile accessory papillary muscle situated between the LV apex and the anteroseptum was seen in 100% of HOCM patients and 62% of control patients (p=0.05) in the CMR images acquired from a total of 9 HOCM and 13 control patients. The same structure was observed in 241 patients representing 69.5% of all-comers echocardiography studies. The age was 69 ± 17 years on average in the echocardiography arm, patients harboring the antero-septal accessory muscle being older (71.6 + 15.7 years old vs 63.5 ± 18.1 for those without, p=0.0005). We exemplify this structure by parasternal long axis still echocardiography images and clips from 24 patients and CMR SSFP still images and a clip from two HOCM patients and one control. . A contractile accessory papillary muscle was observed in more than half of the all-comer echocardiography studies, and in all HOCM patients in the CMR arm. Further research is needed to fully characterize the anatomical and physiological significance as well as the possible structural interventional consequences of this structure attaching in the immediate vicinity of the LVOT in HOCM and control patients.
Topics: Humans; Middle Aged; Aged; Aged, 80 and over; Papillary Muscles; Heart Ventricles; Ventricular Outflow Obstruction; Echocardiography; Cardiomyopathy, Hypertrophic; Magnetic Resonance Imaging
PubMed: 36178793
DOI: 10.2478/rjim-2022-0017 -
Radiology Nov 2022Background The relationship between papillary muscle infarction (papMI) and the culprit coronary lesion has not been fully investigated. Delayed enhancement cardiac MRI...
Background The relationship between papillary muscle infarction (papMI) and the culprit coronary lesion has not been fully investigated. Delayed enhancement cardiac MRI may detect papMI, yet its accuracy is unknown. Flow-independent dark-blood delayed enhancement (FIDDLE) cardiac MRI has been shown to improve the detection of myocardial infarction adjacent to blood pool. Purpose To assess the diagnostic performance of delayed enhancement and FIDDLE cardiac MRI for the detection of papMI, and to investigate the prevalence of papMI and its relationship to the location of the culprit coronary lesion. Materials and Methods A prospective canine study was used to determine the accuracy of conventional delayed enhancement imaging and FIDDLE imaging for detection of papMI, with pathology-based findings as the reference standard. Participants with first-time myocardial infarction with a clear culprit lesion at coronary angiography were prospectively enrolled at a single hospital from 2015 to 2018 and compared against control participants with low Framingham risk scores. In canines, diagnostic accuracy was calculated for delayed enhancement and FIDDLE imaging. Results In canines ( = 27), FIDDLE imaging was more sensitive (100% [23 of 23] vs 57% [13 of 23], < .001) and accurate (100% [54 of 54] vs 80% [43 of 54], = .01) than delayed enhancement imaging for detection of papMI. In 43 participants with myocardial infarction (mean age, 56 years ± 16 [SD]; 28 men), the infarct-related artery was the left anterior descending coronary artery (LAD), left circumflex coronary artery (LCX), and right coronary artery in 47% (20 of 43), 26% (11 of 43), and 28% (12 of 43), respectively. The prevalence of anterior papMI was lower than posterior papMI (37% [16 of 43 participants] vs 44% [19 of 43 participants]) despite more LAD culprit lesions. Culprits leading to papMI were restricted to a smaller "at-risk" portion of the coronary tree for anterior papMI (subtended first diagonal branch of the LAD or first marginal branch of the LCX) compared with posterior (subtended posterior descending artery or third obtuse marginal branch of the LCX). Culprits within these at-risk portions were predictive of papMI at a similar rate (anterior, 83% [15 of 18 participants] vs posterior, 86% [18 of 21 participants]). Conclusion Flow-independent dark-blood delayed enhancement cardiac MRI, unlike conventional delayed enhancement cardiac MRI, was highly accurate in the detection of papillary muscle infarction (papMI). Anterior papMI was less prevalent than posterior papMI, most likely due to culprit lesions being restricted to a smaller portion of the coronary tree rather than because of redundant, dual vascular supply. © RSNA, 2022 See also the editorial by Kawel-Boehm and Bremerich in this issue.
Topics: Male; Humans; Dogs; Animals; Middle Aged; Papillary Muscles; Prospective Studies; Myocardial Infarction; Coronary Vessels; Coronary Angiography; Infarction; Magnetic Resonance Imaging
PubMed: 35880980
DOI: 10.1148/radiol.220251 -
Medicine Nov 2023Deciding whether to include or exclude the papillary muscles and trabeculae to blood pool is essential, because quantifications of left ventricular (LV) functional...
Deciding whether to include or exclude the papillary muscles and trabeculae to blood pool is essential, because quantifications of left ventricular (LV) functional parameters and myocardial mass are significantly affected. As a result, such inclusion or exclusion might produce different indices for diagnosis and therapy. Using cardiac computed tomography (CT), we obtained standard values of the portion of papillary muscle and trabeculae in normal adults, and to find out how the inclusion or exclusion of papillary muscle and trabeculae affect LV functional parameters depending on the patient group. Excluding the papillary muscles from the LV mass results in easier automated contour detection using CT. The percentage portions of papillary muscle and trabeculae to LV end-diastolic volume (EDV) and LV mass (LVM) were 11.9 ± 5.6% and 20.2 ± 4.3%, respectively, significantly affecting disease diagnosis. Imaging should be consistent at follow-up and include or exclude the papillary muscles and trabeculae to avoid introducing significant differences between measurements.
Topics: Adult; Humans; Papillary Muscles; Ventricular Function, Left; Cross-Sectional Studies; Heart Ventricles; Tomography, X-Ray Computed; Stroke Volume; Reproducibility of Results
PubMed: 37986395
DOI: 10.1097/MD.0000000000036106 -
Interactive Cardiovascular and Thoracic... May 2022
Topics: Humans; Disruptive Technology; Mitral Valve Insufficiency; Papillary Muscles; Printing, Three-Dimensional
PubMed: 35137090
DOI: 10.1093/icvts/ivac015 -
JACC. Cardiovascular Imaging Sep 2019This study sought to define interpapillary muscle dyssynchrony as a major contributing factor in functional mitral regurgitation (FMR) and prove the reversibility of FMR... (Observational Study)
Observational Study
OBJECTIVES
This study sought to define interpapillary muscle dyssynchrony as a major contributing factor in functional mitral regurgitation (FMR) and prove the reversibility of FMR by interpapillary muscle resynchronization.
BACKGROUND
Mechanistic features of FMR include papillary muscle displacement due to left ventricular remodeling. Intraventricular conduction delay might further augment this condition by introducing interpapillary muscle dyssynchrony.
METHODS
We enrolled 269 chronic heart failure with reduced ejection fraction patients with conduction delay and comprehensively assessed dyssynchrony by complementary echocardiographic techniques covering the entire spectrum of dyssynchrony.
RESULTS
Patients with severe FMR had markedly increased interpapillary longitudinal dyssynchrony (160 ms [interquartile range (IQR): 120 to 200 ms]) compared with those with moderate (70 ms [IQR: 40 to 110 ms]), no, or mild FMR (60 ms [IQR: 30 to 100 ms]; p < 0.001). Increased interpapillary muscle dyssynchrony was correlated with regurgitant volume (r = 0.50; p < 0.001) and vena contracta width (r = 0.49; p < 0.001). Restoration of longitudinal papillary muscle synchronicity by cardiac resynchronization therapy was correlated with FMR regression, as reflected by the reduction in regurgitant volume (r = 0.46; p < 0.001) and vena contracta width (r = 0.58; p < 0.001). Conversely, the improvement of FMR was associated with improved interpapillary radial (p = 0.006) and longitudinal (p < 0.001) dyssynchrony. The improvement of dyssynchrony-mediated FMR signified a better prognosis compared with no improvement in FMR during the 8-year follow-up period even after comprehensive adjustment by a bootstrap-selected confounder model (adjusted hazard ratio: 0.41; 95% confidence interval: 0.18 to 0.91; p = 0.028). The results remained virtually unchanged after adjustment for left bundle branch block.
CONCLUSIONS
Intraventricular dyssynchrony introduces unequal contraction by papillary muscle bearing walls, which has an adverse effect on FMR. Cardiac resynchronization therapy can effectively restore interpapillary balance and thus create a less tented leaflet configuration, resulting in a clinically meaningful reduction of FMR. The restoration of papillary muscle synchronicity in dyssynchrony-mediated FMR translates into a significantly better prognosis.
Topics: Aged; Cardiac Resynchronization Therapy; Chronic Disease; Female; Heart Failure; Humans; Male; Middle Aged; Mitral Valve; Mitral Valve Insufficiency; Myocardial Contraction; Papillary Muscles; Recovery of Function; Stroke Volume; Treatment Outcome; Ventricular Dysfunction, Left; Ventricular Function, Left; Ventricular Remodeling
PubMed: 30121264
DOI: 10.1016/j.jcmg.2018.06.013 -
JACC. Clinical Electrophysiology Dec 2022
Topics: Humans; Papillary Muscles; Heart Ventricles; Mitral Valve Insufficiency
PubMed: 36543497
DOI: 10.1016/j.jacep.2022.08.030