title: Evaluation of papillary muscle function using cardiovascular magnetic resonance imaging in mitral valve prolapse.
abstract: Abnormal traction and excursion of the papillary muscle (PM) can be observed in patients with mitral valve prolapse (MVP) and can adversely affect the electrophysiologic stability of the underlying myocardium. Cardiovascular magnetic resonance (CMR) techniques can directly measure the excursion and velocity of PM tips during ventricular systole. In addition, high-resolution late gadolinium enhancement (LGE) CMR imaging allows for visualization of the underlying potentially arrhythmogenic PM fibrosis substrate. We prospectively studied 16 patients with MVP and 9 healthy adult subjects using phase-contrast CMR and cine CMR to assess the PM velocity and excursion. LGE CMR was performed in 13 patients with MVP (81%). The peak PM systolic velocity and maximum PM excursion were significantly increased in those with MVP (12 +/- 5 vs 5 +/- 2 cm/s and 15 +/- 5 vs 2 +/- 3 mm, both p <0.001). Definite PM LGE was found in 6 patients (46%) but the finding did not correlate with PM velocity or excursion. In conclusion, functional CMR imaging demonstrated increased peak PM systolic velocity and excursion distance in patients with MVP. These parameters, however, did not relate to underlying PM fibrosis.
authors.affiliation: Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA. yhan@bidmc.harvard.edu
authors.forename: Yuchi
authors.initials: Y
authors.lastname: Han
authors.forename: Dana C
authors.initials: DC
authors.lastname: Peters
authors.forename: Kraig V
authors.initials: KV
authors.lastname: Kissinger
authors.forename: Beth
authors.initials: B
authors.lastname: Goddu
authors.forename: Susan B
authors.initials: SB
authors.lastname: Yeon
authors.forename: Warren J
authors.initials: WJ
authors.lastname: Manning
authors.forename: Reza
authors.initials: R
authors.lastname: Nezafat
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D008945:Mitral Valve Prolapse / Q000175:diagnosis*; D010210:Papillary Muscles / Q000503:physiopathology*