Kılıcgedik Alev, Kahveci Gokhan, Gurbuz Ahmet Seyfeddin, Karabay Can Yucel, Guler Ahmet, Efe Suleyman Cagan, Aung Soe Moe, Arslantas Ugur, Demir Serdar, Izgi Ibrahim Akin, Kirma Cevat
Kartal Koşuyolu Heart & Research Hospital, Department of Cardiology, Turkey.
Arq Bras Cardiol. 2017 Apr;108(4):339-346. doi: 10.5935/abc.20170035.
: The role of papillary muscle function in severe mitral regurgitation with preserved and reduced left ventricular ejection fraction and the method of choice to evaluate PM have still been the subjects of controversy.
: To evaluate and compare papillary muscle function in and between patients with severe degenerative and functional mitral regurgitation by using the free strain method.
: 64 patients with severe mitral regurgitation - 39 patients with degenerative mitral regurgitation (DMR group) and 25 patients with severe functional mitral regurgitation (FMR group) - and 30 control subjects (control group) were included in the study. Papillary muscle function was evaluated through the free strain method from apical four chamber images of the anterolateral papillary muscle (APM) and from apical three chamber images of the posteromedial papillary muscle (PPM). Global left ventricular longitudinal and circumferential strains were evaluated by applying 2D speckle tracking imaging.
: Global left ventricular longitudinal strain (DMR group, -17 [-14.2/-20]; FMR group, -9 [-7/-10.7]; control group, -20 [-18/-21] p < 0.001), global left ventricular circumferential strain (DMR group, -20 [-14.5/-22.7]; FMR group, -10 [-7/-12]; control group, -23 [-21/-27.5] p < 0.001) and papillary musle strains (PPMS; DMR group, -30.5 [-24/-46.7]; FMR group, -18 [-12/-30]; control group; -43 [-34.5/-39.5] p < 0.001; APMS; DMR group, (-35 [-23.5/-43]; FMR group, -20 [-13.5/-26]; control group, -40 [-32.5/-48] p < 0.001) were significantly different among all groups. APMS and PPMS were highly correlated with LVEF (p < 0.001, p < 0.001; respectively), GLS (p < 0.001, p < 0.001; respectively) and GCS (p < 0.001, p < 0.00; respectively) of LV among all groups. No correlation was found between papillary muscle strains and effective orifice area (EOA) in both groups of severe mitral regurgitation.
: Measuring papillary muscle longitudinal strain by the free strain method is practical and applicable. Papillary muscle dysfunction plays a small role in severe MR due to degenerative or functional causes and papillary muscle functions in general seems to follow left ventricular function. PPM is the most affected PM in severe mitral regurgitation in both groups of DMR and FMR.
: O papel da função do músculo papilar na regurgitação mitral grave com fração de ejeção do ventrículo esquerdo preservada e reduzida e o método de escolha para avaliar PM ainda são objetos de controvérsia.
: Avaliar e comparar a função dos músculos papilares entre pacientes com insuficiência mitral funcional e degenerativa pelo método free strain.
MÉTODOS:: 64 pacientes com insuficiência mitral grave - 39 pacientes com insuficiência mitral degenerativa grave (grupo IMD) e 25 com insuficiência mitral funcional grave (grupo IMF) - e 30 indivíduos controle (grupo controle) foram incluídos no estudo. A função dos músculos papilares foi avaliada pelo método free strain a partir de imagens apicais quatro-câmaras do músculo papilar anterolateral (MPA) e imagens apicais três-câmaras do músculo papilar posteromedial (MPP). Strains circunferenciais e longitudinais globais do ventrículo esquerdo foram avaliados por meio de imagens bidimensionais a partir do rastreamento de conjunto de pontos de cinza (speckle tracking).
: O strain longitudinal global do ventrículo esquerdo (grupo IMD, -17 [-14,2/-20]; grupo IMF, -9 [-7/-10,7]; grupo controle, -20 [-18/-21] p < 0,001); strain circunferencial global do ventrículo esquerdo (grupo IMD, -20 [-14,5/-22,7]; grupo IMF, -10 [-7/-12]; grupo controle, -23 [-21/-27,5] p < 0,001) e strains de músculos papilares (MPP; grupo IMD, -30,5 [-24/-46,7]; grupo IMF, -18 [-12/-30]; grupo controle; -43 [-34,5/-39,5] p < 0,001; MPA; grupo IMD, (-35 [-23,5/-43]; grupo IMF, -20 [-13,5/-26]; grupo controle, -40 [-32,5/-48] p < 0,001) mostraram-se significativamente diferentes nos grupos. MPA e MPP mostraram-se altamente correlacionados com a FEVE (p < 0,001, p < 0,00; respectivamente), SLG (p < 0,001, p < 0,001; respectivamente) e SCG (p < 0,001, p < 0,001; respectivamente) do VE entre todos os grupos. Não foi encontrada correlação entre os strains de músculos papilares e área eficaz do orifício (AEO) nos grupos de insuficiência mitral grave.
CONCLUSÕES:: A medição do strain longitudinal de músculos papilares pelo método free strain é prática e aplicável. A disfunção dos músculos papilares tem um papel pequeno em IM grave devido a causas degenerativas e funcionais, e a função dos músculos papilares, em general, parece seguir a função ventricular esquerda. O MPP é o MP mais afetado na insuficiência mitral em ambos os grupos, IMD e IMF.
基础：乳头肌功能在左心室射血分数正常和降低的严重二尖瓣反流中的作用以及评估乳头肌的首选方法仍存在争议。
目的：采用自由应变法评估和比较严重退行性和功能性二尖瓣反流患者之间以及患者自身乳头肌的功能。
方法：本研究纳入64例严重二尖瓣反流患者，其中39例为退行性二尖瓣反流患者（DMR组），25例为严重功能性二尖瓣反流患者（FMR组），以及30名对照者（对照组）。通过自由应变法从心尖四腔心图像评估前外侧乳头肌（APM）的功能，从心尖三腔心图像评估后内侧乳头肌（PPM）的功能。应用二维斑点追踪成像评估左心室整体纵向和圆周应变。
结果：所有组间左心室整体纵向应变（DMR组，-17 [-14.2/-二十]；FMR组，-9 [-7/-10.7]；对照组，-20 [-18/-21] p < 0.001）、左心室整体圆周应变（DMR组，-20 [-14.5/-22.7]；FMR组，-10 [-7/-12]；对照组，-23 [-21/-27.5] p < 0.001）以及乳头肌应变（PPMS；DMR组，-30.5 [-24/-46.7]；FMR组，-18 [-12/-30]；对照组；-43 [-34.5/-39.5] p < 0.001；APMS；DMR组，（-35 [-23.5/-43]；FMR组，-20 [-13.5/-26]；对照组，-40 [-32.5/-48] p < 0.001）均有显著差异。所有组中，APMS和PPMS与左心室的左心室射血分数（LVEF）（分别为p < 0.001，p < 0.001）、整体纵向应变（GLS）（分别为p < 0.001，p < 0.001）和整体圆周应变（GCS）（分别为p < 0.001，p < 0.001）高度相关。在两组严重二尖瓣反流中，未发现乳头肌应变与有效瓣口面积（EOA）之间存在相关性。
结论：采用自由应变法测量乳头肌纵向应变是实用且可行的。乳头肌功能障碍在退行性或功能性原因导致的严重二尖瓣反流中作用较小，总体而言乳头肌功能似乎与左心室功能相关。在DMR和FMR两组严重二尖瓣反流中，PPM是受影响最严重的乳头肌。
基础：乳头肌功能在左心室射血分数保留和降低的严重二尖瓣反流中的作用以及评估乳头肌的首选方法仍存在争议。
目的：通过自由应变法评估和比较严重功能性和退行性二尖瓣反流患者之间乳头肌的功能。
方法：64例严重二尖瓣反流患者——39例严重退行性二尖瓣反流患者（IMD组）和25例严重功能性二尖瓣反流患者（IMF组）——以及30名对照个体（对照组）纳入本研究。通过自由应变法从心尖四腔心图像评估前外侧乳头肌（MPA）的功能，从心尖三腔心图像评估后内侧乳头肌（MPP）的功能。通过二维散斑追踪成像评估左心室的圆周和纵向应变。
结果：左心室整体纵向应变（IMD组，-17 [-14.2/-20]；IMF组，-9 [-7/-10.7]；对照组，-20 [-18/-21] p < 0.001）；左心室整体圆周应变（IMD组，-20 [-14.5/-22.7]；IMF组，-10 [-7/-12]；对照组，-23 [-21/-27.5] p < 0.001）以及乳头肌应变（MPP；IMD组，-30.5 [-24/-46.7]；IMF组，-18 [-12/-30]；对照组；-43 [-34.5/-39.5] p < 0.001；MPA；IMD组，（-35 [-23.5/-43]；IMF组，-20 [-13.5/-26]；对照组，-40 [-32.5/-48] p < 0.001）在各组间有显著差异。所有组中，MPA和MPP与左心室的左心室射血分数（LVEF）（分别为p < 0.001，p < 0.001）、整体纵向应变（SLG）（分别为p < 0.001，p < 0.001）和整体圆周应变（SCG）（分别为p < 0.001，p < 0.001）高度相关。在严重二尖瓣反流组中，未发现乳头肌应变与有效瓣口面积（AEO）之间存在相关性。
结论：通过自由应变法测量乳头肌纵向应变是实用且可行的。乳头肌功能障碍在因退行性和功能性原因导致的严重二尖瓣反流中作用较小，总体而言乳头肌功能似乎与左心室功能相关。在IMD和IMF两组二尖瓣反流中，MPP是受影响最严重的乳头肌。
