Role of regional mechanical dyssynchrony as a determinant of functional mitral regurgitation in patients with left ventricular systolic dysfunction

Agricola, Eustachio; Oppizzi, Michele; Galderisi, Maurizio; Pisani, Matteo; Meris, Alessandra; Pappone, Carlo; Margonato, Alberto

doi:10.1136/hrt.2005.082115

Cited by 61 publications

(59 citation statements)

References 20 publications

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“…In this study with dilated cardiomyopathy patients, the difference between time to peak systolic myocardial strain of myocardial segments adjacent to medial and lateral papillary muscles was found to be related with FMR. Similarly, in another recent study, regional myocardial dyssynchrony was found to be related with FMR (16).…”

Section: Introductionsupporting

confidence: 58%

“…CRT reduces the amount of FMR in patients with left ventricular (LV) systolic failure (9)(10)(11)(12)(13)(14). Studies have shown that the severity of FMR was correlated with the papillary muscle dyssynchrony (PMD) (15)(16)(17)(18). Moreover, PMD was found to predict the improvement of FMR after CRT and help make the choice of treatment options such as CRT with or without mitral valve repair.…”

Section: Introductionmentioning

confidence: 99%

“…In addition, impaired contraction of the papillary muscles itself and the adjacent myocardial segments occurs due to ischemia, scar or remodeling. The resulting dyssynchronic contractions of LV segments and papillary muscles play a role in the development of functional MR (9,(15)(16)(17)(18)22).…”

Section: Introductionmentioning

confidence: 99%

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Functional mitral regurgitation and papillary muscle dyssynchrony in patients with left ventricular systolic dysfunction

Güler¹,

Dündar²,

Tigen³

2011

Anadolu Kardiyol Derg

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ÖZETSistolik fonksiyonları bozuk olan genişlemiş bir kalpte, mitral kapakta yapısal bir bozukluk olmasa bile fonksiyonel olarak yetersizlik meydana gelebilir. Fonksiyonel mitral yetersizliğinin gelişmesinde birçok mekanizma beraber rol alır. Bunlar, mitral kapağı kalbin apeksine doğru çeken kuvvetlerdeki artış, sistol sırasında kapağı kapayıcı kuvvetlerdeki azalma ve mekanik ve elektriksel dissenkronidir. Papiller adele dissenkronisi de fonksiyonel mitral yetersizliğine katkıda bulunan nedenlerden biridir. Sistolik kalp yetersizliği olan hastalarda -bazı durumlarda yanıt alına-mayabilirse de-kardiyak resenkronizasyon tedavisi ile fonksiyonel mitral yetersizliğinin gerilediği bilinir. Papiller adele dissenkronisi fonksiyonel mitral yetersizliğinin gerilemesi bakımından kardiyak resenkronizasyon tedavisine yanıtı tahmin edebilir ve koroner revaskülarizasyon, mitral onarım veya kardiyak resenkronizasyon tedavisi gibi farklı tedavilerden hangisinin seçileceği ya da beraber uygulanacağı konusunda yol göste-rici olabilir. Bu derlemede fonksiyonel mitral yetersizliğinin mekanizmaları, papiller adele dissenkronisi ve fonksiyonel mitral yetersizliği arasın-daki ilişki, papiller adele dissenkronisi ile kardiyak resenkronizasyon tedavisi sonrası fonksiyonel mitral yetersizliğindeki gerileme arasındaki ilişki incelenmiştir. ABSTRACTIn a dilated heart with impaired systolic functions, functional mitral regurgitation could be seen even in the presence of structurally normal mitral apparatus. A number of mechanisms play role in the development of functional mitral regurgitation. These are increased mitral tethering forces, reduction in closing forces and mechanical and electrical dyssynchrony. Papillary muscle dyssynchrony has also been shown to be related with functional mitral regurgitation. Cardiac resynchronization therapy is known to reduce the amount of functional mitral regurgitation in patients with left ventricular systolic failure although some may not respond to treatment with cardiac resynchronization therapy. Papillary muscle dyssynchrony may predict the response of cardiac resynchronization therapy on the regression of functional mitral regurgitation and may suggest the suitable therapeutic options, such as cardiac resynchronization therapy, mitral valve repair, coronary revascularization separately or in combination. In this review, the mechanisms of functional mitral regurgitation, papillary muscle dyssynchrony and its relationship with functional mitral regurgitation and the relationship of papillary muscle dyssynchrony with the improvement of functional mitral regurgitation after cardiac resynchronization therapy are focused. (Anadolu Kardiyol Derg 2011; 11: 450-5)

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Section: Introductionsupporting

confidence: 58%

Section: Introductionmentioning

confidence: 99%

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Functional mitral regurgitation and papillary muscle dyssynchrony in patients with left ventricular systolic dysfunction

Güler¹,

Dündar²,

Tigen³

2011

Anadolu Kardiyol Derg

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“…The degree of tension exerted on the leaflets mainly depends on the entity of PMs displacement, which is the actual cause of the impaired coaptation and valve regurgitation observed in IMR. Tethering can have a symmetric or asymmetric pattern reflecting the direction of PM displacement vector, the localization of myocardial infarction zone and the severity of global ventricular dysfunction (15,16). Normally PMs provide a number of chordae that are attached to both leaflets, anterior and posterior, but with a substantial difference in case of symmetric or asymmetric tethering shape.…”

Section: Diagnosis and Considerations Of Geometric Parameters Conditimentioning

confidence: 99%

Papillary muscle approximation in mitral valve repair for secondary MR

et al. 2017

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“…This results in a vicious circle, with both LV dilatation and FMR acting as self-perpetuating processes. CRT may contribute to the reduction of FMR and reversing LV dilation [6,7].Functional mitral regurgitation, observed in patients with ischaemic and non-ischaemic cardiomyopathy, results from an imbalance between LV closing forces and mitral valve tethering forces, and resultant deformation of mitral valve geometry [2,8]. FMR improvement (FMRI) after CRT implantation is a multistage process being modulated by an array of factors [2,9].…”

mentioning

confidence: 99%

Predictors of functional mitral regurgitation improvement during a short-term follow-up after cardiac resynchronisation therapy

Brzezińska¹,

Łoboz‐Grudzień

Wita

et al. 2016

Kardiol Pol

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A b s t r a c t Background and aim:The study was undertaken to assess the predictive role of myocardial contractile reserve for functional mitral regurgitation (FMR) improvement after cardiac resynchronisation therapy (CRT), and to define other predictors of FMR improvement (FMRI) and the impact of FMRI on left ventricular (LV) reverse remodelling. Methods and results:Among 90 patients in whom echocardiography was performed one day before and six weeks after CRT implantation, 66 with at least FMR(2+) in a four-point scale (mean age 64 ± 10 years, mean LV ejection fraction [LVEF] 25.7 ± 6%, ischaemic aetiology 48%) were included. FMRI was defined as the reduction of the FMR severity by at least one grade. The patients were divided into groups: A with FMRI (n = 30) and B without FMRI (n = 36). Contractile reserve was evaluated using low-dose dobutamine stress-echo before CRT implantation and was defined as a relative improvement in LVEF of more than 20% and segmental contractility improvement. Reverse remodelling was defined as the reduction of the LV end-systolic volume (LVESV) by at least 15%. Cox regression multivariate analysis revealed the following predictors for FMRI: contractile reserve preserved in more than three segments with an OR = 5.7 (95% CI 1.81-17.97, p = 0.005, sensitivity 65.5%, specificity 72.2%, AUC = 0.727) and LV end-diastolic diameter ≤ 74 mm with an OR = 2.09 (95% CI 0.75-5.78, p < 0.05, sensitivity 80.0%, specificity 47.2%, AUC = 0.632). FMRI was associated with greater reduction of LVESV (p = 0.002), greater increase in LVEF (p < 0.001) and higher incidence of the LV reverse remodelling (p < 0.001). Conclusions:Preserved contractile reserve and lesser degree of LV dilation were predictive factors of short-term FMR improvement after CRT implantation. FMR improvement was associated with higher incidence of the LV reverse remodelling early, already in the six weeks after CRT implantation. 666INTRODUCTION Cardiac resynchronisation therapy (CRT) is an established treatment option for patients with advanced chronic heart failure and prolonged QRS duration. The outcome of CRT is determined by a number of factors, and the improvement of functional mitral regurgitation (FMR) is one of the mechanisms behind the beneficial effect of the treatment [1, 2].Significant FMR has important prognostic implications and is associated with a relatively high morbidity and mortality [3]. FMR caused by dilation, altered geometry, and systolic dysfunction of the left ventricle (LV) can itself promote progressive remodelling in the course of ischaemic or non-ischaemic dilated cardiomyopathy [4,5]. This results in a vicious circle, with both LV dilatation and FMR acting as self-perpetuating processes. CRT may contribute to the reduction of FMR and reversing LV dilation [6,7].Functional mitral regurgitation, observed in patients with ischaemic and non-ischaemic cardiomyopathy, results from an imbalance between LV closing forces and mitral valve tethering forces, and resultant deformation of mitral valve geometry ...

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Role of regional mechanical dyssynchrony as a determinant of functional mitral regurgitation in patients with left ventricular systolic dysfunction

Abstract: The degree of FMR is associated mainly with mitral deformation indices. The regional dyssynchrony also has an independent association with ERO but with a minor influence; however, it is not a determinant of FMR in patients with ischaemic LV dysfunction.

Cited by 61 publications

References 20 publications

Functional mitral regurgitation and papillary muscle dyssynchrony in patients with left ventricular systolic dysfunction

Functional mitral regurgitation and papillary muscle dyssynchrony in patients with left ventricular systolic dysfunction

Papillary muscle approximation in mitral valve repair for secondary MR

Predictors of functional mitral regurgitation improvement during a short-term follow-up after cardiac resynchronisation therapy

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