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Journal of Veterinary Internal Medicine 2007Papillary muscle hypertrophy can occur in conjunction with, or as the only indication of, hypertrophic cardiomyopathy or other diseases that result in left ventricular...
BACKGROUND
Papillary muscle hypertrophy can occur in conjunction with, or as the only indication of, hypertrophic cardiomyopathy or other diseases that result in left ventricular concentric hypertrophy (LVCH). Assessment of papillary muscle size is usually subjective because objective measures have not been reported.
HYPOTHESIS
The study hypothesis was that papillary muscle dimensions are different between normal cats and cats with LVCH.
ANIMALS
Echocardiograms from 44 normal cats and 40 cats with LVCH were included in the study.
METHODS
All measurements were taken from the right parasternal short-axis view at the level of the papillary muscles at end-diastole. Three methods were used to assess papillary muscle size: the area subtraction method, the direct area trace method, and the diameter method. Measurements were compared between cat groups and method comparisons were made among methods for area determination.
RESULTS
Cats with LVCH were older and had significantly greater left ventricular septal and free wall thicknesses and larger left atrial measurements than normal cats (P < .0006). Papillary muscle measurements were significantly greater by all measurement methods in cats with LVCH than in cats with normal echocardiograms (P < .0001). The area subtraction method and direct area trace method showed moderate agreement.
CONCLUSIONS AND CLINICAL IMPORTANCE
Papillary muscle measurements were larger for LVCH cats than normal cats; however, some overlap was present. The establishment of these objective measures adds to the echocardiographic examination of cats.
Topics: Animals; Cat Diseases; Cats; Echocardiography; Hypertrophy, Left Ventricular; Papillary Muscles
PubMed: 17708393
DOI: 10.1892/0891-6640(2007)21[737:pmmicw]2.0.co;2 -
JACC. Clinical Electrophysiology Dec 2022Although efficacious, catheter ablation (CA) of ventricular arrhythmias (VAs) originating from left ventricular (LV) papillary muscles (PAPs) has the potential to affect...
BACKGROUND
Although efficacious, catheter ablation (CA) of ventricular arrhythmias (VAs) originating from left ventricular (LV) papillary muscles (PAPs) has the potential to affect mitral valve (MV) function.
OBJECTIVES
The aim of this study was to determine whether lesions delivered during CA of VAs from LV PAPs affected MV function.
METHODS
Consecutive patients undergoing CA of LV PAP VAs from January 2015 to December 2020 in whom both preprocedural and postprocedural transthoracic echocardiography was performed were included. Radiofrequency ablation was performed with an irrigated-tip catheter with or without contact force sensing and intracardiac echocardiographic guidance. The PAPs were delineated into segments: tip, body, and base. Pre- and post-CA transthoracic echocardiograms were reviewed to assess MV regurgitation, which was graded 0 (none), 1 (mild), 2 (moderate), or 3 (severe). A change of ≥2 grades from baseline was considered significant.
RESULTS
A total of 103 patients (mean age 63 ± 15 years, 78% men) were included. VAs were ablated from the anterolateral PAP in 35% (n = 36), posteromedial PAP in 55% (n = 57), and both PAPs in 10% (n = 10). Lesion distribution was as follows: PAP tip in 52 (50%), PAP base in 34 (33%), PAP body in 13 (13%), and entire PAP in 4 (4%). The mean number of lesions delivered was 16 ± 13 (median 14). Of 103 patients, 102 (99%) showed no change in MV function.
CONCLUSIONS
Using intracardiac echocardiographic guidance, lesions can be safely delivered on various aspects of this structure without adverse impact on MV function.
Topics: Male; Humans; Middle Aged; Aged; Female; Papillary Muscles; Tachycardia, Ventricular; Mitral Valve; Arrhythmias, Cardiac; Catheter Ablation
PubMed: 36543496
DOI: 10.1016/j.jacep.2022.07.025 -
Journal of Cardiology Jan 2020Although J-waves have been known to be associated with vulnerability to ventricular fibrillation, their electrophysiologic mechanism remains to be elucidated. The...
BACKGROUND
Although J-waves have been known to be associated with vulnerability to ventricular fibrillation, their electrophysiologic mechanism remains to be elucidated. The papillary muscles (PMs) of the left ventricle (LV) have been recognized as the target site of radiofrequency ablation for ventricular arrhythmias. However, the relationship between PM hypertrophy and J-waves has not been investigated.
OBJECTIVE
To investigate the electrocardiographic characteristics, including the J-waves, in patients with solitary PM hypertrophy.
METHODS
We studied 101 patients with PM hypertrophy without LV hypertrophy (PMH group) and 159 age- and sex-matched control subjects (control group). The parameters of the 12-lead electrocardiogram and the echocardiogram were compared between the two groups.
RESULTS
Compared with the control group, the PMH group had significantly higher incidence (15% vs. 33%, p=0.001) and amplitude (0.17±0.06mV vs. 0.28±0.17mV, p<0.01) of J-waves; significantly longer QRS, QTc, and JTc intervals (p=0.0001, p<0.0001, and p<0.05, respectively); significantly greater Sokolow-Lyon index (p<0.001); and significantly greater LV wall thickness and LV mass index (p<0.0001 for each). Multivariate logistic regression analysis showed that only the PM hypertrophy was an independent predictor of the presence of J-waves.
CONCLUSION
PM hypertrophy was related to the genesis of J-waves.
Topics: Aged; Aged, 80 and over; Echocardiography; Electrocardiography; Female; Humans; Hypertrophy, Left Ventricular; Male; Middle Aged; Papillary Muscles
PubMed: 31327704
DOI: 10.1016/j.jjcc.2019.07.001 -
Circulation Journal : Official Journal... Nov 2022
Topics: Humans; Papillary Muscles; Heart Rupture, Post-Infarction; Myocardial Infarction; Mitral Valve Insufficiency
PubMed: 36047168
DOI: 10.1253/circj.CJ-22-0391 -
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 -
BMC Cardiovascular Disorders Apr 2022Papillary muscle rupture is a rare condition. Its clinical presentation, diagnosis and management can be very challenging for the clinician.
BACKGROUND
Papillary muscle rupture is a rare condition. Its clinical presentation, diagnosis and management can be very challenging for the clinician.
CASE PRESENTATION
A 73-year-old woman with hypertension presented with chest pain, ST-segment changes, and elevated serum troponin levels. Coronary angiography was normal. Echocardiography revealed normal ventricular function, flail posterior mitral leaflet, and severe mitral regurgitation. She underwent emergent mitral valve replacement.
CONCLUSION
The diagnostic and management strategies of this uncommon presentation are discussed.
Topics: Aged; Echocardiography; Female; Heart Rupture; Humans; Mitral Valve; Mitral Valve Insufficiency; Papillary Muscles
PubMed: 35387586
DOI: 10.1186/s12872-022-02570-4 -
British Heart Journal Sep 1977The anatomy of the papillary muscle of the conus, also known as Lancisi's muscle, was studied in 100 normal hearts from pathological collections and in 8 embryonic and...
The anatomy of the papillary muscle of the conus, also known as Lancisi's muscle, was studied in 100 normal hearts from pathological collections and in 8 embryonic and fetal hearts. Wide morphological variations were observed and because of this the name medial papillary complex is proposed. It is concluded that the value of this complex as an anatomical landmark in the right ventricle is a very restricted one. The development of the medial papillary complex is described.
Topics: Adolescent; Adult; Child; Child, Preschool; Fetal Heart; Heart; Humans; Infant; Middle Aged; Papillary Muscles
PubMed: 907765
DOI: 10.1136/hrt.39.9.1012 -
Korean Journal of Radiology Oct 2021Arrhythmogenic mitral valve prolapse (MVP) is an important cause of sudden cardiac death characterized by fibrosis of the papillary muscles or left ventricle (LV) wall,...
OBJECTIVE
Arrhythmogenic mitral valve prolapse (MVP) is an important cause of sudden cardiac death characterized by fibrosis of the papillary muscles or left ventricle (LV) wall, and an association between late gadolinium enhancement (LGE) of the LV papillary muscles and ventricular arrhythmia in MVP has been reported. However, LGE of the papillary muscles may be observed in other causes of mitral regurgitation, and it is not limited to patients with MVP. This study was to evaluate the association of LGE of the LV papillary muscles or ventricular wall on cardiac magnetic resonance imaging (CMR) and ventricular arrhythmia in patients with mitral regurgitation.
MATERIALS AND METHODS
This study included 88 patients (mean age ± standard deviation, 58.3 ± 12.0 years; male, 42%) with mitral regurgitation who underwent CMR. They were allocated to the MVP (n = 43) and non-MVP (n = 45) groups, and their LGE images on CMR, clinical characteristics, echocardiographic findings, and presence of arrhythmia were compared.
RESULTS
LV myocardial wall enhancement was more frequent in the MVP group than in the non-MVP group (28% vs. 11%, = 0.046). Papillary muscle enhancement was observed in 7 (7.9%) patients. Of the 43 patients with MVP, 15 (34.8%) showed LGE in the papillary muscles or LV myocardium, including 12 (27.9%) with LV myocardial wall enhancement and 4 (9.3%) with papillary muscle enhancement. One patient with bilateral diffuse papillary muscle enhancement experienced sudden cardiac arrest due to ventricular fibrillation. Univariable logistic regression analysis showed that high systolic blood pressure (BP; odds ratio [OR], 1.05; 95% confidence interval [CI], 1.01-1.09; = 0.027) and ventricular arrhythmia (OR, 6.84; 95% CI, 1.29-36.19; = 0.024) were significantly associated with LGE of the papillary muscles.
CONCLUSION
LGE of the papillary muscles was present not only in patients with MVP, but also in patients with other etiologies of mitral regurgitation, and it was associated with high systolic BP and ventricular arrhythmia. Papillary muscle enhancement on CMR should not be overlooked.
Topics: Contrast Media; Gadolinium; Heart Ventricles; Humans; Male; Mitral Valve Insufficiency; Papillary Muscles
PubMed: 34402246
DOI: 10.3348/kjr.2020.1485 -
Texas Heart Institute Journal Sep 2021
Topics: Heart Rupture; Heart Rupture, Post-Infarction; Humans; Inferior Wall Myocardial Infarction; Mitral Valve Insufficiency; Papillary Muscles
PubMed: 34637518
DOI: 10.14503/THIJ-18-6717 -
ESC Heart Failure Nov 2017The Frank-Starling mechanism (rapid response (RR)) and the secondary slow response (SR) are known to contribute to increases contractile performance. The contractility...
AIMS
The Frank-Starling mechanism (rapid response (RR)) and the secondary slow response (SR) are known to contribute to increases contractile performance. The contractility of the heart muscle is influenced by pre-load and after-load. Because of the effect of pre-load vs. after-load on these mechanisms in not completely understood, we studied the effect in isolated muscle strips.
METHODS AND RESULTS
Progressive stretch lead to an increase in shortening/force development under isotonic (only pre-load) and isometric conditions (pre- and after-load). Muscle length with maximal function was reached earlier under isotonic (L ) compared with isometric conditions (L ) in nonfailing rabbit, in human atrial and in failing ventricular muscles. Also, SR after stretch from slack to L was comparable under isotonic and isometric conditions (human: isotonic 10 ± 4%, isometric 10 ± 4%). Moreover, a switch from isotonic to isometric conditions at L showed no SR proving independence of after-load. To further analyse the degree of SR on the total contractile performance at higher pre-load muscles were stretched from slack to 98% L under isotonic conditions. Thereby, the SR was 60 ± 9% in rabbit and 51 ± 14% in human muscle strips.
CONCLUSIONS
This work shows that the acute contractile response largely depends on the degree and type of mechanical load. Increased filling of the heart elevates pre-load and prolongs the isotonic part of contraction. The reduction in shortening at higher levels of pre-load is thereby partially compensated by the pre-load-induced SR. After-load shifts the contractile curve to a better 'myofilament function' by probably influencing thin fibers and calcium sensitivity, but has no effect on the SR.
Topics: Adaptation, Physiological; Aged; Animals; Female; Heart Failure; Humans; Isometric Contraction; Isotonic Contraction; Male; Middle Aged; Myocardial Contraction; Papillary Muscles; Rabbits
PubMed: 29154423
DOI: 10.1002/ehf2.12164