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
Introduction: Current echocardiographic parameters have a limitation in assessing mitral valve (MV)apparatus in rheumatic mitral stenosis (MS) patient. In the current study, we use 2 dimensional (2D)longitudinal strai...Introduction: Current echocardiographic parameters have a limitation in assessing mitral valve (MV)apparatus in rheumatic mitral stenosis (MS) patient. In the current study, we use 2 dimensional (2D)longitudinal strain (S) and strain rate (Sr) imaging in evaluating the papillary muscle longitudinal strain (LS) as an objective and quantitative echocardiographic parameter with high reproducibility in the assessment of MV apparatus in patients with mild to moderate rheumatic MS with preserved ejection fraction (EF%).?Patients and Method: The study included 40 patients with established diagnosis of MS subdivided in to 31 patients with moderate MS (mean age: 32 ± 5) and 9 patients with mild MS (mean age: 31 ± 6). 20 healthy individuals (mean age 31 ± 6) as a control for cases. The mitral valve area (MVA) was estimated using planimetry and pressure half time (PHT) methods. 2D longitudinal systolic S and Sr imaging was carried out for all participants from the apical long axis (LAX), 4 chamber (4C), 2 chamber (2C) views. Global longitudinal systolic S and Sr were estimated by averaging the 3 apical views. Longitudinal myocardial strain of papillary muscle PMs was assessed by the use of the free strain method from apical 4 chamber view for the antrolateral papillary muscle (APM) and apical long axis view for postromedial papillary muscle (PPM).?Results: Patients with MS had significantly decreased longitudinal LV systolic S and Sr in comparison with control group (p Conclusion: Patients with MS and preserved EF% had decreased APM-LS & PPM-LS in comparison with control group, and had decreased longitudinal LV systolic S and Sr when compared with control group. 2D strain as well as Sr imaging might be a useful method for assessment of mitral valve apparatus in patients with MS & preserved EF%.展开更多
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Introduction: Current echocardiographic parameters have a limitation in assessing mitral valve (MV)apparatus in rheumatic mitral stenosis (MS) patient. In the current study, we use 2 dimensional (2D)longitudinal strain (S) and strain rate (Sr) imaging in evaluating the papillary muscle longitudinal strain (LS) as an objective and quantitative echocardiographic parameter with high reproducibility in the assessment of MV apparatus in patients with mild to moderate rheumatic MS with preserved ejection fraction (EF%).?Patients and Method: The study included 40 patients with established diagnosis of MS subdivided in to 31 patients with moderate MS (mean age: 32 ± 5) and 9 patients with mild MS (mean age: 31 ± 6). 20 healthy individuals (mean age 31 ± 6) as a control for cases. The mitral valve area (MVA) was estimated using planimetry and pressure half time (PHT) methods. 2D longitudinal systolic S and Sr imaging was carried out for all participants from the apical long axis (LAX), 4 chamber (4C), 2 chamber (2C) views. Global longitudinal systolic S and Sr were estimated by averaging the 3 apical views. Longitudinal myocardial strain of papillary muscle PMs was assessed by the use of the free strain method from apical 4 chamber view for the antrolateral papillary muscle (APM) and apical long axis view for postromedial papillary muscle (PPM).?Results: Patients with MS had significantly decreased longitudinal LV systolic S and Sr in comparison with control group (p Conclusion: Patients with MS and preserved EF% had decreased APM-LS & PPM-LS in comparison with control group, and had decreased longitudinal LV systolic S and Sr when compared with control group. 2D strain as well as Sr imaging might be a useful method for assessment of mitral valve apparatus in patients with MS & preserved EF%.
