Systolic Papillary Muscle Dyssynchrony Predicts Recurrence of Mitral Regurgitation in Patients with Ischemic Cardiomyopathy (ICM) Undergoing Mitral Valve Repair

Abstract

A DYS-PAP cutoff value of 58 msec is useful to identify patients in whom UMRA is likely to fail. That way decision making in ischemic functional MR might be facilitated.

Combined papillary muscle sling and ring annuloplasty for moderate-to-severe secondary mitral regurgitation

“…The mean echocardiographic follow‐up was obtained at seven months in the Ring+Sling cohort, and at 10.1 months in the Ring versus Ring+Sling analysis. Late recurrent MR may occur up to three years following valve repair, while early MR recurrence may improve for up to two years as left ventricular reverse remodeling is completed . Thus, the observed rates of recurrent MR cannot be extrapolated to represent mid‐ or long‐term outcomes.…”

“…Late recurrent MR may occur up to three years following valve repair, while early MR recurrence may improve for up to two years as left ventricular reverse remodeling is completed. 34,35 Thus, the observed rates of recurrent MR cannot be extrapolated to represent mid-or long-term outcomes. In patients with ischemic cardiomyopathy, the extent of ischemic burden was unknown, and there was heterogeneity between the Ring versus Ring+Sling groups with respect to the method and timing of coronary revascularization, which introduces potential uncontrollable confounders.…”

Determinants of Functional Mitral Regurgitation Severity in Patients with Ischemic Cardiomyopathy versus Nonischemic Dilated Cardiomyopathy

“…However, dyssynchronous contraction of papillary muscles may indeed worsen MR and was predictive of late MR recurrence in patients who underwent undersized mitral ring annuloplasty . Effectively addressing papillary muscles dyssynchrony can explain the acute reduction in MR in a subset of patients receiving cardiac resynchronization therapy where the site of latest activation was the posterior or inferior wall adjacent to the posteromedial papillary muscle …”

“…27 In fact, the development of papillary muscle dysfunction with papillary muscle elongation or reduced shortening was found to alleviate in part tethering and MR. 28 However, dyssynchronous contraction of papillary muscles may indeed worsen MR and was predictive of late MR recurrence in patients who underwent undersized mitral ring annuloplasty. 29 Effectively addressing papillary muscles dyssynchrony can explain the acute reduction in MR in a subset of patients receiving cardiac resynchronization therapy where the site of latest activation was the posterior or inferior wall adjacent to the posteromedial papillary muscle. 30 In this study, a subgroup of nine ICM patients exhibited a disproportionate high ERO despite relatively low coaptation height.…”

Ischemic mitral regurgitation

“…Most commonly, the initial insult in patients with chronic ischemic mitral regurgitation is remodeling of the LV following ischemia. Systolic papillary muscle dyssynchrony is also associated with the recurrence of mitral regurgitation following mitral valve repair [6]. Papillary muscle displacement occurs away from the anterior annulus and posterolaterally.…”