Abstract
Papillary muscle (PM) function is vital to mitral valve competence. However, quantitative
assessment of the function is difficult due to the complexity of the mitral apparatus.
We hypothesized that myocardial velocity gradient (MVG) could be applied to assess
PM function. We studied MVG-PM in 123 patients with left ventricular dysfunction (ejection
fraction <40%) and 123 normal subjects throughout a systolic phase. MVG-PM in normal
subjects was significantly higher than in patients with left ventricular dysfunction
(3.6/s vs 1.4/s, p <0.001). MVG-PM reached its peak at early systole and correlated
well with PM thickening (r = 0.89). MVG-PM in patients with left ventricular dysfunction
correlated with the severity of apical tenting of the mitral valve (y = 0.8x − 0.07,
r = 0.72). Patients with lower MVG-PM tended to have less severe mitral regurgitation
(y = 0.03x + 0.3, r = 0.83). PM contractility can be quantitatively assessed by calculating
the MVG derived from tissue Doppler imaging. PM dysfunction, indicated by lower MVG-PM,
decreased mitral leaflet tethering, thus paradoxically decreasing mitral regurgitation
severity. MVG is a useful tool in determining the role of PM in functional mitral
regurgitation.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to American Journal of CardiologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Clinical manifestations of papillary muscle dysfunction.Arch Intern Med. 1963; 59: 508-520
- The syndrome of papillary muscle dysfunction.Ann Intern Med. 1963; 59: 508-520
- Effect of experimental papillary muscle damage on mitral valve closure in intact anesthetized dogs.Mayo Clin Proc. 1970; 45: 275-285
- Combined papillary muscle and left ventricular wall dysfunction as a cause of mitral regurgitation. An experimental study.Circulation. 1971; 44: 174-180
- Mechanism of ischemic mitral regurgitation. An experimental evaluation.Circulation. 1991; 84: 2167-2180
- Two-dimensional echocardiographic assessment of papillary muscle contractility in patients with prior myocardial infarction.J Am Coll Cardiol. 1993; 21: 932-938
- Paradoxic decrease in ischemic mitral regurgitation with papillary muscle dysfunction.Circulation. 2001; 104: 1952-1957
- Myocardial velocity gradient as a new indicator of regional left ventricular contraction.J Am Coll Cardiol. 1995; 26: 217-223
- Quantification of myocardial response to low-dose dobutamine using tissue Doppler echocardiographic measures of velocity and velocity gradient.Am J Cardiol. 1998; 81: 615-623
- Recommendations for quantitation of the left ventricle by two-dimensional echocardiography.J Am Soc Echocardiogr. 1989; 2: 358-367
- Differences in the shape of the normal, cardiomyopathic, and volume overloaded human left ventricle.J Am Soc Echocardiogr. 1989; 2: 408-414
- Size and motion of the mitral valve annulus in man. I. A two-dimensional echocardiographic method and findings in normal subjects.Circulation. 1981; 64: 113-120
- Incomplete mitral leaflet closure in patients with papillary muscle dysfunction.Circulation. 1981; 63: 565-571
- Insights from three-dimensional echocardiography into the mechanism of functional mitral regurgitation.Circulation. 1997; 96: 1999-2008
- Determination of regurgitant fraction in isolated mitral or aortic regurgitation by pulsed Doppler two-dimensional echocardiography.J Am Coll Cardiol. 1986; 7: 1273-1278
- Determination of cardiac output by Doppler echocardiography.Herz. 1986; 11: 258-268
- Color Doppler assessment of mitral regurgitation from orthogonal planes.Circulation. 1987; 75: 175-183
- New method for evaluating left ventricular wall motion by color-coded tissue Doppler imaging.J Am Coll Cardiol. 1995; 25: 717-724
- Determinants of the degree of functional mitral regurgitation in patients with systolic left ventricular dysfunction.Circulation. 2000; 102: 1400-1406
- Left ventricular shape is the primary determinant of functional mitral regurgitation in heart failure.J Am Coll Cardiol. 1992; 20: 1594-1598
- Usefulness of myocardial velocity gradient derived from two-dimensional tissue Doppler imaging as an indicator of regional myocardial contraction independent of translational motion assessed in atrial septal defect.Am J Cardiol. 1997; 79: 237-241
- Differences in myocardial velocity gradient measured throughout the cardiac cycle in patients with hypertrophic cardiomyopathy, athletes, and patients with left ventricular hypertrophy due to hypertension.J Am Coll Cardiol. 1997; 30: 760-768
Article info
Publication history
Accepted:
March 4,
2004
Received in revised form:
March 4,
2004
Received:
September 2,
2003
Identification
Copyright
© 2004 Excerpta Medica Inc. Published by Elsevier Inc. All rights reserved.
