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Systolic Papillary Muscle Dyssynchrony Predicts Recurrence of Mitral Regurgitation in Patients with Ischemic Cardiomyopathy ( ICM ) Undergoing Mitral Valve Repair
Author(s) -
Garsse Leen,
Gelsomino Sandro,
Parise Orlando,
Lucà Fabiana,
Cheriex Emile,
Lorusso Roberto,
Vizzardi Enrico,
Rao Carmelo Massimiliano,
Gensini Gian Franco,
Maessen Jos
Publication year - 2012
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/j.1540-8175.2012.01789.x
Subject(s) - medicine , cardiology , ejection fraction , mitral regurgitation , sinus rhythm , papillary muscle , clinical endpoint , cardiomyopathy , mitral valve , mitral valve repair , heart failure , atrial fibrillation , randomized controlled trial
Objective: We investigated the impact of papillary muscle dyssynchrony ( DYS ‐ PAP ) in predicting recurrent mitral regurgitation ( MR ) in patients with ischemic cardiomyopathy ( ICM ) undergoing undersized mitral ring annuloplasty ( UMRA ). Methods: One hundred forty‐four ICM patients (left ventricular ejection fraction <35%) in sinus rhythm undergoing UMRA between January 2001 and December 2010 at three Institutions (University Hospital, Maastricht, The Netherlands; Careggi Hospital, Florence, Italy; Civic Hospital, Brescia, Italy) were recruited. The primary endpoint was the recurrence of MR at the latest echocardiographic study defined as insufficiency ≥2+ in patients with no/trivial MR at discharge. The assessment of DYS‐PAP was performed by applying two‐dimensional (2D) speckle‐tracking imaging. Results: In patients with MR recurrence, DYS ‐ PAP significantly worsened (84.1 ± 8.8 msec vs.65.4 ± 8.8 msec at baseline, P < 0.001) whereas in patients with no MR recurrence, DYS ‐ PAP did not vary (22.3 ± 5.3 msec vs. 25.9 ± 7.2 msec at baseline, P = 0.8). Recurrent MR was positively correlated with preoperative DYS ‐ PAP (P < 0.001), baseline anterior mitral leaflet tethering angle α (P < 0.001) and tethering symmetry index α/β before surgery (P < 0.001). There was no significant correlation between MR recurrence and other echocardiographic parameters. Logistic regression analysis revealed that baseline values of DYS ‐ PAP ( OR : 5.4 [95% CI : 3.1–7.7], P < 0.001), α ( OR : 5.0 [2.6–6.7], P < 0.001), and α/β ( OR : 3.9 [2.5–5.7], p < 0.001) were predictors of recurrent MR . A DYS ‐ PAP value ≥ 58 msec predicted recurrence of MR with 100% sensitivity and 83% specificity (area under the curve [ AUC ]: 0.92 [0.7–1], P < 0.001). Conclusions: 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.