Department of Congenital Heart Disease in Adults, Institute of Cardiology, Alpejska, Warsaw, Poland.
Scand Cardiovasc J. 2012 Feb;46(1):16-22. doi: 10.3109/14017431.2011.636452. Epub 2011 Dec 8.
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).
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.
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.
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.
乳头肌（PM）不同步是导致二尖瓣反流（MR）的重要机制之一。本研究旨在探讨缺血性和非缺血性心肌病（ICM 和 nICM）患者 PM 不同步程度与 MR 程度之间的潜在关系。
研究纳入了 21 例射血分数（EF）≤35%且窦性心律的 ICM 患者和 10 例 nICM 患者。使用标准超声心动图和组织多普勒成像分别获取描述 MR 程度和二尖瓣装置及 PM 功能变形的参数。前外侧和后内侧 PM 的应变达峰时间（ε）差异超过 65ms 被认为存在 PM 不同步。
PM 不同步与二尖瓣幕状区和左心房面积相关。nICM PM 不同步与 nICM LAA 的相关性更强，远远超过了 ICM 患者的相关性。PM 不同步与其余表征 MR 程度的指数之间的关系较弱。
PM 不同步不能反映 MR 程度，但似乎与幕状区测量的二尖瓣装置变形有关。在 nICM 患者中，PM 不同步比 ICM 患者更能准确地描述 MR 的血液动力学后果的程度。
