Papillary muscle dyssynchrony in patients with systolic left ventricular dysfunction.
OBJECTIVE
Papillary muscles (PM) dyssynchrony is among the crucial mechanisms leading to mitral valve regurgitation (MR). The purpose of this study was to find a potential relationship between the level of PM asynchrony and the degree of MR in patients with ischemic and nonischemic cardiomyopathies (ICM and nICM, respectively).


METHODS
Twenty-one ICM and ten nICM patients with EF ≤ 35% and sinus rhythm were enrolled in the study. The parameters describing the degree of MR and the deformation of mitral apparatus and PM function were obtained using standard echocardiography and tissue Doppler imaging, respectively. The difference of 65 ms and more in time to peak strain (ε) between anterolateral and postero-medial PM was considered indicative of PM dyssynchrony.


RESULTS
PM dyssynchrony correlated with mitral tenting area and left atrial area. The correlation between nICM PM dyssynchrony and nICM LAA was stronger and far exceeded the one observed for ICM patients. The relationship between the PM asynchrony and the remainder of the indices characterizing the degree of MR was weak.


CONCLUSIONS
PM dyssynchrony did not reflect the degree of MR but seems to be associated with the deformation of mitral apparatus measured by tenting area. The level of haemodynamic consequences of MR can be better characterized by PM dyssynchrony in nICM than in ICM patients.
Department of Congenital Heart Disease in Adults, Institute of Cardiology, Alpejska, Warsaw, Poland. mkordybach@ikard.pl
Maria
M
Kordybach
Miroslaw
M
Kowalski
Ewa
E
Kowalik
Piotr
P
Hoffman
D000368:Aged; D000818:Animals; D001145:Arrhythmias, Cardiac / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology*; D010210:Papillary Muscles / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D013599:Systole; D014463:Ultrasonography; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology*