Posterior shift of the anterior papillary muscle in patients with heart failure: a potential role in the effect of cardiac resynchronization therapy.
The anatomical relationship between left ventricular pacing site and the anterior papillary muscle (A-PM) may have a major influence on the improvement of mitral regurgitation (MR) in cardiac resynchronization therapy (CRT). The aims of the present study were to assess the anatomical relationship between coronary veins and papillary muscles in patients with and without heart failure (HF), and to examine its contribution to the response to CRT. Sixty-one patients (36 patients with HF, 25 patients without HF) who underwent multi-detector computed tomography were studied. We measured the angle between the anterior papillary muscle and coronary veins (Ang. 1) and the angle between the anterior edge of the left ventricular free wall and A-PM (Ang. 2). Angle 1 of the posterolateral vein in the patients with HF was significantly smaller than those without HF (54.9 +/- 11.1, 68.7 +/- 15.8 degrees, respectively, P = 0.02). Supportively, Angle 2 of patients with HF was larger than that of patients without HF (100 +/- 13.0, 87.3 +/- 10.7 degrees, respectively, P < 0.01). Significant decreases in left ventricular end-diastolic diameter, the grade of MR, and brain natriuretic peptide level after 6 months of CRT were observed (P < 0.01, P = 0.04, P < 0.01, respectively) in patients with severe A-PM displacement (Ang. 2 > 100 degrees), but not in patients with Ang. 2 < 100 degrees. A-PM tends to be located in a more posterior wall in patients with HF. Displacement of A-PM may have a potential role as a predictor of the response to CRT.
Hara
Tetsuya
T
Division of Cardiovascular and Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School, Hyogo, Japan.
Yamashiro
Kohei
K
Okajima
Katsunori
K
Hayashi
Takatoshi
T
Kajiya
Teishi
T
D000368:Aged; D002304:Cardiac Pacing, Artificial; D003331:Coronary Vessels / Q000503:physiopathology; D005260:Female; D006333:Heart Failure / Q000503:physiopathology*; D006801:Humans; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000032:analysis; D010210:Papillary Muscles / Q000473:pathology / Q000503:physiopathology*; D012189:Retrospective Studies; D014680:Veins / Q000503:physiopathology
D020097:Natriuretic Peptide, Brain