Functional mitral regurgitation is a common finding among heart failure patients with ischemic and non-ischemic dilated cardiomyopathies.The presence of moderate or severe mitral regurgitation is associated with highe...Functional mitral regurgitation is a common finding among heart failure patients with ischemic and non-ischemic dilated cardiomyopathies.The presence of moderate or severe mitral regurgitation is associated with higher morbidity and mortality.Heart failure patients meeting electrocardiogram and left ventricle function criteria are good candidates for cardiac resynchronization therapy,which may reduce the degree of functional mitral regurgitation in the short and long term,specifically targeting myocardial dyssynchrony and inducing left ventricle reverse remodeling.In this article,we analyze data from the literature about predictors of mitral regurgitation improvement after cardiac resynchronization therapy implantation.展开更多
Objective: To evaluate LV papillary muscles (PM) function using transesophageal echocardiography (TEE), and to determine the relationship between PM function and mitral regurgitation in patients with normal left ventr...Objective: To evaluate LV papillary muscles (PM) function using transesophageal echocardiography (TEE), and to determine the relationship between PM function and mitral regurgitation in patients with normal left ventricular sys-tolic function. Design: TEE examinations were prospectively performed. End diastolic and end systolic PM lengths were obtained from the transgastric long axis views and fractional systolic shortening (FS) was calculated. LV ejection fraction was determined using modified Simpson rule and mitral regurgitation was determined using regurgitant jet area by color flow. Setting: Tertiary Center. Patients: 85 consecutive adult patients (51 with mitral regurgitation and 34 without) with normal LV chamber dimensions and LV systolic function, meeting enrollment criteria. Results: The % FS in patients with mitral regurgitation was 21.7 ± 3.6% for anterior PM (APM) and 18.7 ± 4.6% for posterior PM (PPM). In those without mitral regurgitation, the values were as follows;22.6 ± 5.4% (APM) and 19.5 ± 3.8% (PPM). In a subgroup of patients with severe mitral regurgitation (n = 23), the values for PM FS were 20.3 ± 6.8 (APM) and 18.4 ± 6.9 % (PPM). There was no statistically significant difference in PM fractional shortening between the groups. Anterior papillary muscle length was longer in those patients with mitral regurgitation compared to those without [(End-diastolic length (cm): 3.38 ± 0.61 v 2.88 ± 0.47(p: 0.008) and end-systolic length of 2.46 ± 0.51 v 2.17 ± 0.33 (p: 0.04)]. These differences are more pronounced in those with severe mitral regurgitation (p: 0.002 and 0.004 for EDL and ESL respectively. Conclusion: In patients with normal LVEF, PM contraction is similar in those with and without MR. In patients with MR however, anterior PM length (ED & ES) is significantly increased. Our data suggests that in patients with normal LVEF, PM dysfunction appears to play no significant role in the causation of MR. Anterior papillary muscle length however, appears to be a major determinant of mitral regurgitation in such patients.展开更多
Background and aim:Gapping formation of the mitral valve cleft is unknown.The objective of this study was to quantify the geometry of mitral valve cleft coaptation in the asymmetric and symmetric papillary muscles(PMs...Background and aim:Gapping formation of the mitral valve cleft is unknown.The objective of this study was to quantify the geometry of mitral valve cleft coaptation in the asymmetric and symmetric papillary muscles(PMs)positions in a dilated annulus in order to reveal mitral valve gapping mechanism.Methods:Nine fresh porcine mitral valves with the posterior leaflet clefts were sutured onto a saddle-shaped dilated annulus in an in-vitro experiment to simulate mitral valve closure at hydrostatic pressure.PMs were adjusted to the normal position,and subsequently to positions of asymmetric and symmetric PM displacement.Sonomicrometry was used to measure positions of the lateral and medial clefts.Results:PM displacement tethered the leaflets.Both the opening angle and contact angle of the lateral cleft,but not of the medial cleft,increased in the asymmetric PM displacement.Neither the opening angle nor contact angle of both clefts increased in the symmetric PM displacement.Conclusions:Displacement of the postero-medial PM moves the posterior leaflet medially and impairs coaptation of the lateral cleft,but not medial cleft,which suggest that the medial cleft displacement in the asymmetric PM position is another mechanism of gap formation in addition to leaflet tenting due to apical leaflet displacement.Symmetric PM displacement cause leaflet tenting,but doesn’t impair the leaflet cleft coaptation,which suggest that the asymmetric PM position is even worse than the symmetric PM position.展开更多
Background:Functional mitral regurgitation(FMR)is common in critically ill patients and may cause left atrial(LA)pressure elevation.This study aims to explore the prognostic impact of synergistic LA pressure elevation...Background:Functional mitral regurgitation(FMR)is common in critically ill patients and may cause left atrial(LA)pressure elevation.This study aims to explore the prognostic impact of synergistic LA pressure elevation and FMR in patients with shock.Methods:We retrospectively screened 130 consecutive patients of 175 patients with shock from April 2016 to June 2017.The incidence and impact of FMR and early diastolic transmitral velocity to early mitral annulus diastolic velocity ratio(E/e’)≥4 within 6 h of shock on the prognosis of patients were evaluated.Finally,the synergistic effect of FMR and E/e’were assessed by combination,grouping,and trend analyses.Results:Forty-four patients(33.8%)had FMR,and 15 patients(11.5%)had E/e’elevation.A multivariate analysis revealed FMR and E/e’as independent correlated factors for 28-day mortality(P=0.043 and 0.028,respectively).The Kaplan-Meier survival analysis revealed a significant difference in survival between patients with and without FMR(χ2=7.672,P=0.006)and between the E/e’≥14 and E/e’<14 groups(χ2=19.351,P<0.010).Twenty-eight-day mortality was significantly different among the four groups(χ2=30.141,P<0.010).The risk of 28-day mortality was significantly higher in group 4(E/e’≥14 with FMR)compared with groups 1(E/e’<14 without FMR)and 2(E/e’<14 with FMR)(P=0.001 and 0.046,respectively).Conclusions:Patients with shock can be identified by the presence of FMR.FMR and E/e’are independent risk factors for a poor prognosis in these patients,and prognosis is worst when FMR and E/e’≥14 are present.It may be possible to improve prognosis by reducing LA pressure and E/e’.Trial Registration:ClinicalTrials.gov,NCT03082326.展开更多
文摘Functional mitral regurgitation is a common finding among heart failure patients with ischemic and non-ischemic dilated cardiomyopathies.The presence of moderate or severe mitral regurgitation is associated with higher morbidity and mortality.Heart failure patients meeting electrocardiogram and left ventricle function criteria are good candidates for cardiac resynchronization therapy,which may reduce the degree of functional mitral regurgitation in the short and long term,specifically targeting myocardial dyssynchrony and inducing left ventricle reverse remodeling.In this article,we analyze data from the literature about predictors of mitral regurgitation improvement after cardiac resynchronization therapy implantation.
文摘Objective: To evaluate LV papillary muscles (PM) function using transesophageal echocardiography (TEE), and to determine the relationship between PM function and mitral regurgitation in patients with normal left ventricular sys-tolic function. Design: TEE examinations were prospectively performed. End diastolic and end systolic PM lengths were obtained from the transgastric long axis views and fractional systolic shortening (FS) was calculated. LV ejection fraction was determined using modified Simpson rule and mitral regurgitation was determined using regurgitant jet area by color flow. Setting: Tertiary Center. Patients: 85 consecutive adult patients (51 with mitral regurgitation and 34 without) with normal LV chamber dimensions and LV systolic function, meeting enrollment criteria. Results: The % FS in patients with mitral regurgitation was 21.7 ± 3.6% for anterior PM (APM) and 18.7 ± 4.6% for posterior PM (PPM). In those without mitral regurgitation, the values were as follows;22.6 ± 5.4% (APM) and 19.5 ± 3.8% (PPM). In a subgroup of patients with severe mitral regurgitation (n = 23), the values for PM FS were 20.3 ± 6.8 (APM) and 18.4 ± 6.9 % (PPM). There was no statistically significant difference in PM fractional shortening between the groups. Anterior papillary muscle length was longer in those patients with mitral regurgitation compared to those without [(End-diastolic length (cm): 3.38 ± 0.61 v 2.88 ± 0.47(p: 0.008) and end-systolic length of 2.46 ± 0.51 v 2.17 ± 0.33 (p: 0.04)]. These differences are more pronounced in those with severe mitral regurgitation (p: 0.002 and 0.004 for EDL and ESL respectively. Conclusion: In patients with normal LVEF, PM contraction is similar in those with and without MR. In patients with MR however, anterior PM length (ED & ES) is significantly increased. Our data suggests that in patients with normal LVEF, PM dysfunction appears to play no significant role in the causation of MR. Anterior papillary muscle length however, appears to be a major determinant of mitral regurgitation in such patients.
文摘Background and aim:Gapping formation of the mitral valve cleft is unknown.The objective of this study was to quantify the geometry of mitral valve cleft coaptation in the asymmetric and symmetric papillary muscles(PMs)positions in a dilated annulus in order to reveal mitral valve gapping mechanism.Methods:Nine fresh porcine mitral valves with the posterior leaflet clefts were sutured onto a saddle-shaped dilated annulus in an in-vitro experiment to simulate mitral valve closure at hydrostatic pressure.PMs were adjusted to the normal position,and subsequently to positions of asymmetric and symmetric PM displacement.Sonomicrometry was used to measure positions of the lateral and medial clefts.Results:PM displacement tethered the leaflets.Both the opening angle and contact angle of the lateral cleft,but not of the medial cleft,increased in the asymmetric PM displacement.Neither the opening angle nor contact angle of both clefts increased in the symmetric PM displacement.Conclusions:Displacement of the postero-medial PM moves the posterior leaflet medially and impairs coaptation of the lateral cleft,but not medial cleft,which suggest that the medial cleft displacement in the asymmetric PM position is another mechanism of gap formation in addition to leaflet tenting due to apical leaflet displacement.Symmetric PM displacement cause leaflet tenting,but doesn’t impair the leaflet cleft coaptation,which suggest that the asymmetric PM position is even worse than the symmetric PM position.
基金supported by grant from the Sichuan Province Science and Technology Support Program(No.2019YFS0449).
文摘Background:Functional mitral regurgitation(FMR)is common in critically ill patients and may cause left atrial(LA)pressure elevation.This study aims to explore the prognostic impact of synergistic LA pressure elevation and FMR in patients with shock.Methods:We retrospectively screened 130 consecutive patients of 175 patients with shock from April 2016 to June 2017.The incidence and impact of FMR and early diastolic transmitral velocity to early mitral annulus diastolic velocity ratio(E/e’)≥4 within 6 h of shock on the prognosis of patients were evaluated.Finally,the synergistic effect of FMR and E/e’were assessed by combination,grouping,and trend analyses.Results:Forty-four patients(33.8%)had FMR,and 15 patients(11.5%)had E/e’elevation.A multivariate analysis revealed FMR and E/e’as independent correlated factors for 28-day mortality(P=0.043 and 0.028,respectively).The Kaplan-Meier survival analysis revealed a significant difference in survival between patients with and without FMR(χ2=7.672,P=0.006)and between the E/e’≥14 and E/e’<14 groups(χ2=19.351,P<0.010).Twenty-eight-day mortality was significantly different among the four groups(χ2=30.141,P<0.010).The risk of 28-day mortality was significantly higher in group 4(E/e’≥14 with FMR)compared with groups 1(E/e’<14 without FMR)and 2(E/e’<14 with FMR)(P=0.001 and 0.046,respectively).Conclusions:Patients with shock can be identified by the presence of FMR.FMR and E/e’are independent risk factors for a poor prognosis in these patients,and prognosis is worst when FMR and E/e’≥14 are present.It may be possible to improve prognosis by reducing LA pressure and E/e’.Trial Registration:ClinicalTrials.gov,NCT03082326.
