title: Strain balance of papillary muscles as a prerequisite for successful mitral valve repair in patients with mitral valve prolapse due to fibroelastic deficiency.
abstract: OBJECTIVE
  The aim of this study was to assess the papillary muscle strain as a contributor to recurrent mitral regurgitation (MR) after mitral valve repair for fibroelastic deficiency.
  
  
  RESULTS
  Sixty-four patients with isolated posterior mitral valve prolapse and severe MR referred for surgery were prospectively recruited between 2008 and 2012. Two- and three-dimensional echocardiography and speckle tracking were performed in all patients. The longitudinal strain of the anterolateral (AL) and posteromedial (PM) papillary muscles was individually calculated as well as the global longitudinal strain of both papillary muscles was measured before and after mitral repair and normalized to left ventricle end-diastolic volume. Eight patients (12.5%) had at least moderate MR 6 months after mitral repair. The longitudinal strain of the AL (preop -4.94 ± 2.2 vs. postop -3.28 ± 1.3, P < 0.001) and the PM papillary muscles (preop -12.64 ± 5.3 vs. postop -4.12 ± 6.77, P < 0.001) as well as the global strain of both papillary muscles (preop -7.59 ± 3.48 vs. postop -1.07 ± 6, P < 0.001) were all reduced after surgical repair. The longitudinal strain of the PM papillary muscle was the strongest predictor of recurrent MR (when less than or equal to -14.78). The global preoperative papillary muscle strain was also a determinant of recurrent MR when the global strain was greater than -9.05% (area under the curve: 0.895, sensitivity: 100%, and specificity: 76.8%).
  
  
  CONCLUSIONS
  Patients with isolated posterior mitral leaflet prolapse are less likely having any residual MR post repair when the global papillary muscle strain of both papillary muscles is close or equal to zero. Strain of the papillary muscles may be an important determinant in predicting residual MR in patients who undergo mitral valve repair.
authors.affiliation: Department of Cardiovascular Sciences, Hammersmith Hospital, Imperial College London, NHLI, Hammersmith Hospital, London W12 1NN, UK.
authors.forename: Julia
authors.initials: J
authors.lastname: Grapsa
authors.affiliation: Department of Cardiovascular Sciences, Hammersmith Hospital, Imperial College London, NHLI, Hammersmith Hospital, London W12 1NN, UK.
authors.forename: Ines
authors.initials: I
authors.lastname: Zimbarra Cabrita
authors.affiliation: Department of Cardiothoracic Surgery, Hammersmith Hospital, Imperial College London, London, UK.
authors.forename: Gentjan
authors.initials: G
authors.lastname: Jakaj
authors.affiliation: Department of Cardiovascular Sciences, Hammersmith Hospital, Imperial College London, NHLI, Hammersmith Hospital, London W12 1NN, UK.
authors.forename: Evangelia
authors.initials: E
authors.lastname: Ntalarizou
authors.affiliation: Department of Cardiovascular Sciences, Hammersmith Hospital, Imperial College London, NHLI, Hammersmith Hospital, London W12 1NN, UK.
authors.forename: Andreas
authors.initials: A
authors.lastname: Serapheim
authors.affiliation: Department of Cardiovascular Sciences, Hammersmith Hospital, Imperial College London, NHLI, Hammersmith Hospital, London W12 1NN, UK.
authors.forename: Ozan M
authors.initials: OM
authors.lastname: Demir
authors.affiliation: Department of Cardiovascular Sciences, Hammersmith Hospital, Imperial College London, NHLI, Hammersmith Hospital, London W12 1NN, UK.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Smith
authors.affiliation: Department of Cardiovascular Sciences, Hammersmith Hospital, Imperial College London, NHLI, Hammersmith Hospital, London W12 1NN, UK.
authors.forename: David
authors.initials: D
authors.lastname: Dawson
authors.affiliation: Department of Cardiothoracic Surgery, Hammersmith Hospital, Imperial College London, London, UK.
authors.forename: Aziz
authors.initials: A
authors.lastname: Momin
authors.affiliation: Department of Cardiothoracic Surgery, Hammersmith Hospital, Imperial College London, London, UK.
authors.forename: Prakash P
authors.initials: PP
authors.lastname: Punjabi
authors.affiliation: Columbia University Medical Center, St. Luke's-Roosevelt Hospital, New York, NY, USA.
authors.forename: Constantine E
authors.initials: CE
authors.lastname: Anagnostopoulos
authors.affiliation: Department of Cardiovascular Sciences, Hammersmith Hospital, Imperial College London, NHLI, Hammersmith Hospital, London W12 1NN, UK petros@imperial.ac.uk.
authors.forename: Petros
authors.initials: P
authors.lastname: Nihoyannopoulos
mesh_terms: D000368:Aged; D058385:Cardiac Valve Annuloplasty / Q000009:adverse effects / Q000379:methods*; D016022:Case-Control Studies; D019560:Echocardiography, Three-Dimensional / Q000379:methods*; D004548:Elasticity; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000601:surgery*; D008945:Mitral Valve Prolapse / Q000000981:diagnostic imaging / Q000601:surgery*; D010210:Papillary Muscles / Q000000981:diagnostic imaging* / Q000503:physiopathology; D012372:ROC Curve; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment
keywords: Echocardiography; Mitral valve disease; Papillary muscles; Speckle tracking; Strain