title: Two-dimensional echocardiographic assessment of papillary muscle contractility in patients with prior myocardial infarction.
abstract: OBJECTIVE
  This study was performed to assess the length and contractile performance of human left ventricular papillary muscles and to determine the relation between papillary muscle dysfunction and mitral regurgitation.
  
  
  BACKGROUND
  Assessment of human papillary muscle contractility remains a clinical challenge.
  
  
  METHODS
  Two-dimensional echocardiographic examinations were performed in 16 normal subjects and 31 patients with prior myocardial infarction. Apical echocardiograms were used to obtain long-axis views of the anterior and posterior papillary muscles. The end-systolic and end-diastolic lengths of the papillary muscles were measured and fractional shortening was calculated.
  
  
  RESULTS
  Fractional shortening in normal subjects was 27 +/- 8% for the anterior papillary muscle and 30 +/- 8% for the posterior papillary muscle. In patients with prior myocardial infarction, a significant decrease in fractional shortening was observed in proportion to the severity of left ventricular wall motion abnormalities at the site of papillary muscle implantation. Moderate or severe mitral regurgitation was significantly more frequent in patients with combined anterior and posterior papillary muscle dysfunction than in those with isolated anterior or posterior dysfunction or with normal function of both papillary muscles (p < 0.05).
  
  
  CONCLUSIONS
  Two-dimensional echocardiography is useful for demonstrating abnormal contractility of human left ventricular papillary muscles. Papillary muscle contractility should be analyzed in each case to elucidate the mechanism of mitral regurgitation in patients with papillary muscle dysfunction.
authors.affiliation: First Department of Internal Medicine, Faculty of Medicine, Kagoshima University, Japan.
authors.forename: A
authors.initials: A
authors.lastname: Kisanuki
authors.forename: Y
authors.initials: Y
authors.lastname: Otsuji
authors.forename: R
authors.initials: R
authors.lastname: Kuroiwa
authors.forename: T
authors.initials: T
authors.lastname: Murayama
authors.forename: R
authors.initials: R
authors.lastname: Matsushita
authors.forename: K
authors.initials: K
authors.lastname: Shibata
authors.forename: T
authors.initials: T
authors.lastname: Yutsudo
authors.forename: S
authors.initials: S
authors.lastname: Nakao
authors.forename: K
authors.initials: K
authors.lastname: Nomoto
authors.forename: T
authors.initials: T
authors.lastname: Tomari
mesh_terms: D000328:Adult; D000368:Aged; D009202:Cardiomyopathies / Q000150:complications / Q000503:physiopathology; D016022:Case-Control Studies; D004452:Echocardiography; D015150:Echocardiography, Doppler; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000209:etiology / Q000503:physiopathology; D009119:Muscle Contraction; D009203:Myocardial Infarction / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology*; D010210:Papillary Muscles / Q000000981:diagnostic imaging / Q000502:physiology / Q000503:physiopathology*