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Impact of Preserved Myocardial Contractile Function in the Segments Attached to the Papillary Muscles on Reduction in Functional Mitral Regurgitation
Author(s) -
Tatsumi Kazuhiro,
Tanaka Hidekazu,
Kataoka Toshiya,
Norisada Kazuko,
Onishi Tetsuari,
Kawai Hiroya,
Hirata Kenichi
Publication year - 2013
Publication title -
echocardiography
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.404
H-Index - 62
eISSN - 1540-8175
pISSN - 0742-2822
DOI - 10.1111/echo.12024
Subject(s) - cardiology , dobutamine , ejection fraction , medicine , papillary muscle , functional mitral regurgitation , mitral valve , mitral regurgitation , cardiomyopathy , heart failure , hemodynamics
Background: Effectiveness of functional mitral regurgitation ( FMR ) in heart failure patients is of growing importance for patient prognosis. The purpose of this study was to investigate whether regional myocardial contractile function as assessed by tissue D oppler strain rate imaging can predict reduction in FMR caused by dobutamine. Methods: Fifty‐one patients with depressed left ventricular ( LV ) ejection fraction (32 ± 9%) secondary to dilated cardiomyopathy and FMR underwent evaluation of effective regurgitant orifice ( ERO ) of FMR , mitral valve deformation, global LV remodeling, and regional myocardial contractile function assessed by longitudinal peak systolic strain rate ( S sr) in 6 mid‐ LV segments from standard apical views. We also determined the average S sr of segments attached to the papillary muscles, that is, the inferior, inferolateral, and anterolateral segments ( PM segments S sr). Low‐dose (10 μg/kg per minute) dobutamine‐induced reduction in ERO was compared with baseline variables. Results: Baseline valve tenting was associated with dobutamine‐induced reduction in ERO (r = −0.30, P < 0.05). Receiver operating characteristic curve analysis showed that baseline valve tenting, LV sphericity index, inferior S sr, inferolateral S sr, and PM segments S sr were predictors of dobutamine‐induced ≥30% reduction in ERO . Importantly, only PM segments S sr predicted dobutamine‐induced ≥20% reduction in valve tenting with area under the curve of 0.67 (P < 0.05). Conclusions: Preserved myocardial contractile function in the segments attached to the PM s was associated with dobutamine‐induced reduction in mitral valve tenting and FMR , suggesting that our findings are important for improvement in cardiac function and FMR with medical treatment.