title: Accessory papillary muscles and papillary muscle hypertrophy are associated with sudden cardiac arrest of unknown cause.
abstract: BACKGROUND
  The present study was performed for elucidating the associations between the morphology of the papillary muscles (PMs) and sudden cardiac arrest (SCA).
  
  
  METHODS
  We retrospectively reviewed history, laboratory data, electrocardiography, echocardiography, coronary angiography, and cardiac CT/MRI for 190 patients with SCA. The prevalence of accessory PMs and PM hypertrophy in patients with SCA of unknown cause was compared with that in patients with SCA of known causes and 98 age- and sex-matched patients without SCA. An accessory PM was defined as a PM with origins separated from the anterolateral and posteromedial PMs, or a PM that branched into two or three bellies at the base of the anterolateral or posteromedial PM. PM hypertrophy was defined as at least one of the two PMs having a diameter of ≥1.1cm.
  
  
  RESULTS
  In 49 patients (age 49.9±15.9years; 38 men) the cause of SCA was unknown, whereas 141 (age 54.2±16.6years; 121 men) had a known cause. The prevalence of accessory PMs was significantly higher in the unknown-cause group than in the known-cause group (24.5% and 7.8%, respectively; p=0.002) or the no-SCA group (7.1%, p=0.003). The same was true for PM hypertrophy (unknown-cause 12.2%, known-cause 2.1%, p=0.010; no SCA group 1.0%, p=0.006). By logistic regression, accessory PM and PM hypertrophy were independently associated with sudden cardiac arrest of unknown cause.
  
  
  CONCLUSIONS
  An accessory PM and PM hypertrophy are associated with SCA of unknown cause.
authors.affiliation: Department of Cardiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Jae-Sun
authors.initials: JS
authors.lastname: Uhm
authors.affiliation: Department of Cardiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Jong-Chan
authors.initials: JC
authors.lastname: Youn
authors.affiliation: Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Hye-Jeong
authors.initials: HJ
authors.lastname: Lee
authors.affiliation: Department of Cardiology, Ewha Womans University School of Medicine, Seoul, Korea.
authors.forename: Junbeom
authors.initials: J
authors.lastname: Park
authors.affiliation: Department of Cardiology, Hanyang University Medical Center, Seoul, Korea.
authors.forename: Jin-Kyu
authors.initials: JK
authors.lastname: Park
authors.affiliation: Department of Cardiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Chi Young
authors.initials: CY
authors.lastname: Shim
authors.affiliation: Department of Cardiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Geu-Ru
authors.initials: GR
authors.lastname: Hong
authors.affiliation: Department of Cardiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Boyoung
authors.initials: B
authors.lastname: Joung
authors.affiliation: Department of Cardiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Hui-Nam
authors.initials: HN
authors.lastname: Pak
authors.affiliation: Department of Cardiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea. Electronic address: mhlee@yuhs.ac.
authors.forename: Moon-Hyoung
authors.initials: MH
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D006332:Cardiomegaly / Q000150:complications* / Q000175:diagnosis*; D016757:Death, Sudden, Cardiac / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010210:Papillary Muscles / Q000473:pathology*; D012189:Retrospective Studies
keywords: Hypertrophy; Papillary muscle; Sudden cardiac arrest; Ventricular fibrillation