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Sakai A, Nagao M, Yamamoto A, Nakao R, Arashi H, Momose M, Sato K, Yamaguchi J. 13N-ammonia positron emission tomography for diagnosis and monitoring of ischemia without obstructive coronary artery disease. Int J Cardiol 2024; 395:131392. [PMID: 37748522 DOI: 10.1016/j.ijcard.2023.131392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 09/20/2023] [Accepted: 09/22/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUND Ischemia with no obstructive coronary arteries (INOCA), a chronic disorder with a poor prognosis, remains challenging to diagnose. 13N-ammonia positron emission tomography (13NH3 PET), which can quantify microcirculation, is its most reliable detection method. We aimed to investigate the differences in 13NH3 PET findings between INOCA and coronary artery disease (CAD). METHODS Overall, consecutive 433 patients with known or suspected CAD underwent adenosine-stress 13NH3 PET. Based on the European Society of Cardiology guidelines, INOCA was defined as typical angina without coronary stenosis (INOCA n = 45, CAD n = 293, no CAD n = 95). Papillary muscle ischemia (PMI) and global myocardial flow reserve (MFR) were examined as microvascular injuries using 13NH3 PET. RESULTS PMI was observed significantly more frequently in patients with INOCA than in those with CAD (40.0% vs. 11.6%, respectively; p = 0.02). Global MFR (1.84 ± 0.54 vs. 2.08 ± 0.66, respectively; p < 0.0001) and reactive hyperemia index were significantly lower in patients with INOCA than in those with CAD. Forty-five major adverse cardiac events (MACE) were recorded in a median follow-up time of 827 days. Kaplan-Meier analysis revealed that the survival rate worsened in patients with INOCA and PMI (log-rank test, p = 0.001). In the Cox proportional hazards model, PMI was an independent predictive factor for MACE (odds ratio, 4.16; 95% confidence interval, 2.13-8.15; p < 0.0001). CONCLUSIONS PMI presence and decreased MFR were 13NH3 PET findings characteristic of INOCA. 13NH3 PET can be used to monitor the treatment course.
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Affiliation(s)
- Akiko Sakai
- Department of Cardiology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjyuku-ku, Tokyo 162-8666, Japan.
| | - Michinobu Nagao
- Department of Diagnostic Imaging & Nuclear Medicine, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjyuku-ku, Tokyo 162-8666, Japan
| | - Atsushi Yamamoto
- Department of Diagnostic Imaging & Nuclear Medicine, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjyuku-ku, Tokyo 162-8666, Japan
| | - Risako Nakao
- Department of Cardiology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjyuku-ku, Tokyo 162-8666, Japan
| | - Hiroyuki Arashi
- Department of Cardiology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjyuku-ku, Tokyo 162-8666, Japan
| | - Mitsuru Momose
- Department of Diagnostic Imaging & Nuclear Medicine, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjyuku-ku, Tokyo 162-8666, Japan
| | - Kayoko Sato
- Department of Cardiology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjyuku-ku, Tokyo 162-8666, Japan
| | - Junichi Yamaguchi
- Department of Cardiology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjyuku-ku, Tokyo 162-8666, Japan
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Pambianchi G, Giannetti M, Marchitelli L, Cundari G, Maestrini V, Mancone M, Francone M, Catalano C, Galea N. Papillary Muscle Involvement during Acute Myocardial Infarction: Detection by Cardiovascular Magnetic Resonance Using T1 Mapping Technique and Papillary Longitudinal Strain. J Clin Med 2023; 12:jcm12041497. [PMID: 36836032 PMCID: PMC9963367 DOI: 10.3390/jcm12041497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/10/2023] [Accepted: 02/11/2023] [Indexed: 02/16/2023] Open
Abstract
Papillary muscle (PPM) involvement in myocardial infarction (MI) increases the risk of secondary mitral valve regurgitation or PPM rupture and may be diagnosed using late gadolinium enhancement (LGE) imaging. The native T1-mapping (nT1) technique and PPM longitudinal strain (PPM-ls) have been used to identify PPM infarction (iPPM) without the use of the contrast agent. This study aimed to assess the diagnostic performance of nT1 and PPM-ls in the identification of iPPM. Forty-six patients, who performed CMR within 14-30 days after MI, were retrospectively enrolled: sixteen showed signs of iPPM on LGE images. nT1 values were measured within the infarcted area (IA), remote myocardium (RM), blood pool (BP), and anterolateral and posteromedial PPMs and compared using ANOVA. PPM-ls values have been assessed on cineMR images as the percentage of shortening between end-diastolic and end-systolic phases. Higher nT1 values and lower PPM-ls were found in infarcted compared to non-infarcted PPMs (nT1: 1219.3 ± 102.5 ms vs. 1052.2 ± 80.5 ms and 17.6 ± 6.3% vs. 21.6 ± 4.3%; p-value < 0.001 for both), with no significant differences between the nT1 of infarcted PPMs and IA and between the non-infarcted PPMs and RM. ROC analysis demonstrated an excellent discriminatory power for nT1 in detecting the iPPM (AUC = 0.874; 95% CI: 0.784-0.963; p < 0.001). nT1 and PPM-ls are valid tools in assessing iPPM with the advantage of avoiding contrast media administration.
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Affiliation(s)
- Giacomo Pambianchi
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, 00161 Rome, Italy
| | - Martina Giannetti
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, 00161 Rome, Italy
| | - Livia Marchitelli
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, 00161 Rome, Italy
| | - Giulia Cundari
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, 00161 Rome, Italy
| | - Viviana Maestrini
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, “Policlinico Umberto I” Hospital, 00161 Rome, Italy
| | - Massimo Mancone
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, “Policlinico Umberto I” Hospital, 00161 Rome, Italy
| | - Marco Francone
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy
- IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy
| | - Carlo Catalano
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, 00161 Rome, Italy
| | - Nicola Galea
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, 00161 Rome, Italy
- Correspondence:
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Bhadoria P, Bisht K, Singh B, Tiwari V. Cadaveric Study on the Morphology and Morphometry of Heart Papillary Muscles. Cureus 2022; 14:e22722. [PMID: 35382408 PMCID: PMC8975613 DOI: 10.7759/cureus.22722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2022] [Indexed: 11/05/2022] Open
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Aminu AJ, Chen W, Yin Z, Kuniewicz M, Walocha J, Perde F, Molenaar P, Iaizzo PA, Dobrzynski H, Atkinson AJ. Novel micro-computed tomography contrast agents to visualise the human cardiac conduction system and surrounding structures in hearts from normal, aged, and obese individuals. TRANSLATIONAL RESEARCH IN ANATOMY 2022. [DOI: 10.1016/j.tria.2022.100175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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5
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Aryal SR, Bajaj NS, Bhambhvani PG. Papillary muscle ischemia and myocardial blood flow on N13-ammonia positron emission tomography myocardial perfusion imaging. J Nucl Cardiol 2022; 29:304-306. [PMID: 32909237 DOI: 10.1007/s12350-020-02336-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 08/06/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Sudeep Raj Aryal
- Division of Cardiovascular Disease, The University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Navkaranbir S Bajaj
- Division of Cardiovascular Disease, The University of Alabama at Birmingham, Birmingham, AL, USA
- Division of Molecular Imaging and Therapeutics, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Pradeep G Bhambhvani
- Division of Molecular Imaging and Therapeutics, The University of Alabama at Birmingham, Birmingham, AL, USA.
- The University of Alabama in Birmingham, 619 19th St S, Suite 777, Birmingham, AL, 35249, USA.
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Axelsson E, Ljungvall I, Bhoumik P, Conn LB, Muren E, Ohlsson Å, Olsen LH, Engdahl K, Hagman R, Hanson J, Kryvokhyzha D, Pettersson M, Grenet O, Moggs J, Del Rio-Espinola A, Epe C, Taillon B, Tawari N, Mane S, Hawkins T, Hedhammar Å, Gruet P, Häggström J, Lindblad-Toh K. The genetic consequences of dog breed formation-Accumulation of deleterious genetic variation and fixation of mutations associated with myxomatous mitral valve disease in cavalier King Charles spaniels. PLoS Genet 2021; 17:e1009726. [PMID: 34473707 PMCID: PMC8412370 DOI: 10.1371/journal.pgen.1009726] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 07/20/2021] [Indexed: 02/07/2023] Open
Abstract
Selective breeding for desirable traits in strictly controlled populations has generated an extraordinary diversity in canine morphology and behaviour, but has also led to loss of genetic variation and random entrapment of disease alleles. As a consequence, specific diseases are now prevalent in certain breeds, but whether the recent breeding practice led to an overall increase in genetic load remains unclear. Here we generate whole genome sequencing (WGS) data from 20 dogs per breed from eight breeds and document a ~10% rise in the number of derived alleles per genome at evolutionarily conserved sites in the heavily bottlenecked cavalier King Charles spaniel breed (cKCs) relative to in most breeds studied here. Our finding represents the first clear indication of a relative increase in levels of deleterious genetic variation in a specific breed, arguing that recent breeding practices probably were associated with an accumulation of genetic load in dogs. We then use the WGS data to identify candidate risk alleles for the most common cause for veterinary care in cKCs–the heart disease myxomatous mitral valve disease (MMVD). We verify a potential link to MMVD for candidate variants near the heart specific NEBL gene in a dachshund population and show that two of the NEBL candidate variants have regulatory potential in heart-derived cell lines and are associated with reduced NEBL isoform nebulette expression in papillary muscle (but not in mitral valve, nor in left ventricular wall). Alleles linked to reduced nebulette expression may hence predispose cKCs and other breeds to MMVD via loss of papillary muscle integrity. As a consequence of selective breeding, specific disease-causing mutations have become more frequent in certain dog breeds. Whether the breeding practice also resulted in a general increase in the overall number of disease-causing mutations per dog genome is however not clear. To address this question, we compare the amount of harmful, potentially disease-causing, mutations in dogs from eight common breeds that have experienced varying degrees of intense selective breeding. We find that individuals belonging to the breed affected by the most intense breeding—cavalier King Charles spaniel (cKCs)—carry more harmful variants than other breeds, indicating that past breeding practices may have increased the overall levels of harmful genetic variation in dogs. The most common disease in cKCs is myxomatous mitral valve disease (MMVD). To identify variants linked to this disease we next characterize mutations that are common in cKCs, but rare in other breeds, and then investigate if these mutations can predict MMVD in dachshunds. We find that variants that regulate the expression of the gene NEBL in papillary muscles may increase the risk of the disease, indicating that loss of papillary muscle integrity could contribute to the development of MMVD.
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Affiliation(s)
- Erik Axelsson
- Science for Life Laboratory, Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden
- * E-mail:
| | - Ingrid Ljungvall
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - Priyasma Bhoumik
- Translational Medicine, Novartis Institutes for BioMedical Research, Basel, Switzerland
| | - Laura Bas Conn
- Science for Life Laboratory, Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden
| | - Eva Muren
- Science for Life Laboratory, Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden
| | - Åsa Ohlsson
- Department of Animal Breeding and Genetics, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - Lisbeth Høier Olsen
- Department of Veterinary and Animal Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Karolina Engdahl
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - Ragnvi Hagman
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - Jeanette Hanson
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - Dmytro Kryvokhyzha
- Science for Life Laboratory, Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden
| | - Mats Pettersson
- Science for Life Laboratory, Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden
| | - Olivier Grenet
- Translational Medicine, Novartis Institutes for BioMedical Research, Basel, Switzerland
| | - Jonathan Moggs
- Translational Medicine, Novartis Institutes for BioMedical Research, Basel, Switzerland
| | | | - Christian Epe
- Elanco Animal Health, Greenfield, Indiana, United States of America
| | - Bruce Taillon
- Elanco Animal Health, Greenfield, Indiana, United States of America
| | - Nilesh Tawari
- Elanco Animal Health, Greenfield, Indiana, United States of America
| | - Shrinivas Mane
- Elanco Animal Health, Greenfield, Indiana, United States of America
| | - Troy Hawkins
- Elanco Animal Health, Greenfield, Indiana, United States of America
| | - Åke Hedhammar
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | | | - Jens Häggström
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - Kerstin Lindblad-Toh
- Science for Life Laboratory, Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts, United States of America
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Joseph N, Craft M, Mill L, Erickson CC, Danford DA, Kutty S, Li L. Assessment of mitral valve function in children and young adults with hypertrophic cardiomyopathy using three-dimensional echocardiography. Int J Cardiol 2021; 332:182-188. [PMID: 33753187 DOI: 10.1016/j.ijcard.2021.03.040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 03/09/2021] [Accepted: 03/15/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The objective of this study was to assess papillary muscle (PM) and mitral valve (MV) structure and function in children and young adults with mild and moderate hypertrophic cardiomyopathy (HCM) using real-time three-dimensional echocardiography (3DE) and to correlate them with HCM related adverse outcomes. METHODS Transthoracic research 3DE was performed in HCM patients and controls matched for age and gender. Anterolateral and posteromedial PM mass, apical displacement of anterolateral PM, and left ventricular (LV) mass were measured and indexed to body surface area. The MV annulus and leaflet structure and function were analyzed. Individual PMs were manually planimetered by tracing the endocardial borders on each mid systole frame, taking care to distinguish PMs as distinct from the LV wall. Apical PM displacement was expressed as ratio of the distance between the apex and the base of the anterolateral PM to the entire length of the LV lateral wall (APL index). All 3DE measurements were correlated to adverse outcomes. RESULTS Forty subjects were studied, including 20 HCM patients (age 18.1 ± 9.6 years, 16 male and 4 female), and 20 controls (18.2 ± 9.6 years, 16 male and 4 female). The indexed LV mass in HCM was 74.8 ± 25.8 g/m2 compared to 50.8 ± 12.4 g/m2 in controls (p = 0.001). The anterolateral, posteromedial and combined PM mass were 3.1 ± 2.2 g/m2, 1.7 ± 1.2 g/m2 and 4.9 ± 2.7 g/m2 in HCM, in contrast to respective measurements of 1.1 ± 0.6 g/m2, 1.2 ± 0.6 g/m2 and 2.3 ± 0.8 g/m2 in controls (p < 0.001, p = 0.062, and p < 0.001, respectively). The mitral valve annular parameters (annulus circumference, height and area) in HCM were not significantly different from controls. The APL index in HCM was less than in controls (0.44 ± 0.07 vs. 0.55 ± 0.04, p < 0.001). The LV lateral wall length and LV mass correlated with adverse HCM outcomes, while the APL index and PM total mass were not associated with adverse events. CONCLUSION It is feasible to evaluate PM muscles and MV annulus geometry in children and young adults with HCM using 3DE. The morphologic and functional changes of anterolateral PM may occur in the absence of MV annulus changes. Prospective validation will be required to determine if LV lateral wall length and LV mass may be used as predictors of adverse events.
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Affiliation(s)
- Navya Joseph
- University of Nebraska Medical Center, Omaha, NE, United States
| | - Mary Craft
- University of Nebraska Medical Center, Omaha, NE, United States; Children's Hospital and Medical Center, Omaha, NE, United States
| | - LuAnn Mill
- University of Nebraska Medical Center, Omaha, NE, United States
| | - Christopher C Erickson
- University of Nebraska Medical Center, Omaha, NE, United States; Children's Hospital and Medical Center, Omaha, NE, United States
| | - David A Danford
- University of Nebraska Medical Center, Omaha, NE, United States; Children's Hospital and Medical Center, Omaha, NE, United States
| | - Shelby Kutty
- Johns Hopkins Hospital and School of Medicine, Baltimore, MD, United States.
| | - Ling Li
- University of Nebraska Medical Center, Omaha, NE, United States; Children's Hospital and Medical Center, Omaha, NE, United States
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Lei D, Xie J, Dai Q, Huang Y, Wei X, Mu D, Bao X, Li J, Xu B. Prognostic relevance and clinical features of papillary muscle infarction with mitral regurgitation in patients with ST segment elevation myocardial infarction. J Thorac Dis 2021; 13:334-342. [PMID: 33569213 PMCID: PMC7867801 DOI: 10.21037/jtd-20-3476] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background Papillary muscle infarction (PapMI) combined with mitral regurgitation (MR) is a severe complication of ST-segment elevation myocardial infarction (STEMI). The features detected by cardiac magnetic resonance (CMR) imaging in PapMI have not been characterized. The aim of the present study was to assess the incidence, determinants, and the prognostic significance of PapMI with MR at 1-year follow-up in a study of patients with STEMI after primary percutaneous coronary intervention (pPCI). Methods We enrolled 209 patients with STEMI reperfused by pPCI (<12 hours after symptom onset) at 2 centers. CMR and echocardiography were performed within 1 week after infarction using a standardized protocol. According to the results of CMR and echocardiography, patients were divided into PapMI with MR, PapMI (PapMI without MR), and non-PapMI groups. The primary clinical endpoint of the study was the occurrence of major adverse cardiovascular events (MACE). Results PapMI with MR was found in 27 patients (13%). The existence of PapMI with MR was associated with age (P<0.001), impaired left ventricular ejection fraction (LVEF) (P=0.005), higher SYNTAX score (P=0.002), concentration of troponin I (P<0.001), longer time to reperfusion (P<0.001), more diabetics (P<0.001), and microvascular occlusion (MVO) (P<0.001). Binary logistic regression with stepwise backward selection analysis showed that advanced age, MVO, and impaired LVEF were independent risk factors for PapMI with MR. Patients in the PapMI with MR group had significantly more MACE compared with the PapMI and non-PapMI groups [PapMI with MR, 23 (85.2%) vs. PapMI, 21 (55.3%) vs. non-PapMI, 29 (20.1%)] at 1-year follow-up (P<0.001). However, there were no pronounced differences in mortality rates among the 3 groups (P=0.071). Conclusions The presence of PapMI with MR in patients with STEMI is associated with advanced age, MVO, and impaired LVEF, which can increase the rates of MACE.
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Affiliation(s)
- Dazhou Lei
- Department of Cardiology, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China
| | - Jun Xie
- Department of Cardiology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Qing Dai
- Department of Cardiology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Yinhao Huang
- Department of Cardiology, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China
| | - Xuan Wei
- Department of Cardiology, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China
| | - Dan Mu
- Department of Cardiology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Xue Bao
- Department of Cardiology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Jianhui Li
- Department of Cardiology, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China
| | - Biao Xu
- Department of Cardiology, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China.,Department of Cardiology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
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Diaz Babio G, Vera Janavel GL, Carrero C, Masson Juarez G, Mezzadra M, Constantin I, Garcia Botta T, Stutzbach P. Papillary muscles. Dark side of the heart: A simple approach for a forgotten structure. Echocardiography 2020; 37:993-998. [PMID: 32608129 DOI: 10.1111/echo.14785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 06/13/2020] [Accepted: 06/15/2020] [Indexed: 10/24/2022] Open
Abstract
PURPOSE Transthoracic echocardiography (TTE) is currently the election method for initial screening of left ventricular papillary muscles (PM). However, diagnosis of borderline PM hypertrophy with TTE is not always feasible due to cumbersome interpretation of different PM diameters and the absence of precise normal ranges in the literature. The objective of this study was to obtain TTE normal cutoff values and to describe convenient indexes of PM dimensions. METHODS Healthy volunteers with normal electrocardiogram were included for TTE assessment. Vertical (Vd) and horizontal (Hd) PM diameters were measured to obtain maximum diameter (Md) and areas of the anterolateral PM (APM) and posteromedial PM (PPM) to obtain PM total area (PMTA). RESULTS A total of 82 patients were screened, and 6 (7.3%) with bifid PM were excluded from analysis. APM and PPM had similar Vd (APM: 8.3 ± 1.2, PPM: 7.9 ± 1.1 mm2 , P = NS) and Hd (APM: 8.2 ± 1.3, PPM: 8.3 ± 1.2 mm2 , P = NS). Finally, Md (9 ± 1.2 mm; P95 = 11 mm) and PMTA (106.5 ± 24.2 mm2 ; P95 = 150.8 mm2 ) were obtained. Correlation between PMTA and Md was positive (P < .001), and out-of-range values for Md and PMTA were similar (2.6% vs 5.3%); there was excellent agreement between both indexes (K = 0.82). CONCLUSIONS Maximum diameter and PMTA are convenient indexes to describe PM dimensions. However, given the high equivalence between both indexes, we propose the use of Md due to its simplicity and ease of calculation. Our findings suggest that patients with any PM diameter ≥12 mm should be considered abnormal.
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Affiliation(s)
- Gonzalo Diaz Babio
- Department of Echocardiography, ICSI Sanatorio Las Lomas, San Isidro, Argentina
| | | | - Celeste Carrero
- Department of Echocardiography, ICSI Sanatorio Las Lomas, San Isidro, Argentina
| | | | - María Mezzadra
- Department of Echocardiography, ICSI Sanatorio Las Lomas, San Isidro, Argentina
| | - Ivan Constantin
- Department of Echocardiography, ICSI Sanatorio Las Lomas, San Isidro, Argentina
| | | | - Pablo Stutzbach
- Department of Cardiology, ICSI Sanatorio Las Lomas, San Isidro, Argentina
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Gooden SCM, Hatoum H, Zhang W, Boudoulas KD, Dasi LP. Multiple MitraClips: The balancing act between pressure gradient and regurgitation. J Thorac Cardiovasc Surg 2020; 163:1319-1327.e1. [PMID: 32711989 DOI: 10.1016/j.jtcvs.2020.05.049] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 05/13/2020] [Accepted: 05/18/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Transcatheter mitral valve repair with the MitraClip is used for the symptomatic management of mitral regurgitation (MR). The challenge is reducing MR while avoiding an elevated mitral valve gradient (MVG). This study assesses how multiple MitraClips used to treat MR can affect valve performance. METHODS Six porcine mitral valves were assessed using an in vitro left heart simulator in the native, moderate-to-severe MR, and severe MR cases. MR cases were tested in the no-MitraClip, 1-MitraClip, and 2-MitraClip configurations. Mitral regurgitant fraction (MRF), MVG, and effective orifice area (EOA) were quantified. RESULTS Native MRF, MVG, and EOA were 14.22%, 2.59 mm Hg, and 1.64 cm2, respectively. For moderate-to-severe MR, MRF, MVG, and EOA were 34.07%, 3.31 mm Hg, and 2.22 cm2, respectively. Compared with the no-MitraClip case, 1 MitraClip decreased MRF to 18.57% (P < .0001) and EOA to 1.50 cm2 (P = .0002). MVG remained statistically unchanged (3.44 mm Hg). Two MitraClips decreased MRF to 14.26% (P < .0001) and EOA to 1.36 cm2 (P = .0001). MVG remained unchanged (3.29 mm Hg). For severe MR, MRF, MVG, and EOA were 59.79%, 4.98 mm Hg, and 2.73 cm2, respectively. Compared with the no-MitraClip case, 1 MitraClip decreased MRF to 30.72% (P < .0001) and EOA to 1.82 cm2 (P < .0001); MVG remained unchanged (4.03 mm Hg). MVG remained statistically unchanged. Two MitraClips decreased MRF to 23.10% (P < .0001) and EOA to 1.58 cm2 (P < .0001); MVG remained statistically unchanged (3.82 mm Hg). Both MR models yielded no statistical difference between 1 and 2 MitraClips. CONCLUSIONS There is limited concern regarding elevation of MVG when reducing MR using 1 or 2 MitraClips, although 2 MitraClips did not significantly continue to reduce MRF.
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Affiliation(s)
| | - Hoda Hatoum
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Ga
| | - Wei Zhang
- Department of Biostatistics and Data Science, UTHealth, School of Public Health, Houston, Tex
| | | | - Lakshmi Prasad Dasi
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Ga.
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Mukherjee A, Ravindranath S. Is it septic or cardiogenic shock? Papillary muscle rupture masquerading as sepsis. Australas J Ultrasound Med 2019; 22:51-55. [PMID: 34760537 PMCID: PMC8411685 DOI: 10.1002/ajum.12117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Rupture of a papillary muscle is an extremely rare but catastrophic complication of an acute myocardial infarction. Survival is time dependent on the expedition of the patient from the area of presentation to the operating theatre for surgery. Diagnosis in the ED is possible within minutes of presentation if an echo is performed by an emergency physician skilled in echocardiography, as we demonstrate. CASE PRESENTATION We present a case of a 59 years male self-presenting to the emergency department with undifferentiated shock. An EP performed echo directed us towards the rare but correct diagnosis. He was then transferred for percutaneous coronary intervention and surgical management. CONCLUSION Often in the past a diagnosis made on coronary care units or post-mortem, we believe this diagnosis in the future will be made more frequently at the bedside in emergency departments across the world as emergency physicians continue to incorporate echocardiography as a skill in their diagnostic armoury.
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Affiliation(s)
- Ashes Mukherjee
- Department of Emergency MedicineArmadale HospitalArmadaleWestern AustraliaAustralia
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Khan MS, Biederman R. Dynamic cardiac anatomy: the "cypress tree" papillary muscle root. J Cardiovasc Thorac Res 2018; 10:138-143. [PMID: 30386533 PMCID: PMC6203870 DOI: 10.15171/jcvtr.2018.22] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Accepted: 09/05/2018] [Indexed: 11/09/2022] Open
Abstract
Introduction: The understanding of gross cardiac anatomy has been relatively stable over the last
80 years, reliant on well-established autopsy findings. The advent of dynamic imaging by cardiac
MRI and CT provides a window to view anatomic features in vivo, providing insights typically
masked at autopsy due to death.
Hypothesis: We hypothesize that cardiac magnetic resonance (CMR) with its high spatial and
temporal resolution allows detection of anatomic features not previously appreciated at autopsy.
Methods: Two hundred fifty-five sequential, CMR examinations were retrospectively examined
to describe the anatomic features of the LV (left ventricular) PM (papillary muscles). Specifically,
the origin of the base of the PM was delineated. The insertion of the PM was seen in 255/255
patients.
Results: In 249 out of 255 patients (97.6%), the appearance of the PM was not a uniform muscle
arising from the inner face of the LV myocardium, but was a finger-like series of long, slender
trabeculae carneae traversing >1 cm before inserting into the main body of PM challenging our
previous understanding of PM anatomy.
Conclusion: The capabilities of dynamic CMR to view cardiac features in vivo non-invasively
provides a useful tool to study cardiac anatomy. Unlike the widely accepted representation of
papillary muscles, uniformly arising from the floor of the LV, the base resolves into a ‘cypress-tree’
root-like structure with multiple thin projections before coalescing into a thick muscle head. Such
observations have far reaching clinical implications in areas such as mitral regurgitation, post-MI
remodeling and electrical transmission of the His-Purkinje system, and further work is indicated
to delineate the role of non-invasive imaging in these areas.
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Affiliation(s)
| | - Robert Biederman
- Department of Cardiac MRI, Allegheny General Hospital, Pittsburgh, USA
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Duchenne J, Turco A, Bézy S, Ünlü S, Pagourelias ED, Beela AS, Degtiarova G, Vunckx K, Nuyts J, Coudyzer W, Claus P, Rega F, Gheysens O, Voigt JU. Papillary muscles contribute significantly more to left ventricular work in dilated hearts. Eur Heart J Cardiovasc Imaging 2018; 20:84-91. [DOI: 10.1093/ehjci/jey043] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 02/27/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jürgen Duchenne
- Department of Cardiovascular Sciences, KU Leuven—University of Leuven, Herestraat 49, Leuven, Belgium
- Department of Cardiovascular Diseases, University Hospitals Leuven, Herestraat 49, Leuven, Belgium
| | - Anna Turco
- Department of Imaging and Pathology, KU Leuven—University of Leuven, Herestraat 49, Leuven, Belgium
- Department of Nuclear Medicine and Molecular Imaging, University Hospitals Leuven, Herestraat 49, Leuven, Belgium
| | - Stéphanie Bézy
- Department of Cardiovascular Sciences, KU Leuven—University of Leuven, Herestraat 49, Leuven, Belgium
- Department of Cardiovascular Diseases, University Hospitals Leuven, Herestraat 49, Leuven, Belgium
| | - Serkan Ünlü
- Department of Cardiovascular Sciences, KU Leuven—University of Leuven, Herestraat 49, Leuven, Belgium
- Department of Cardiovascular Diseases, University Hospitals Leuven, Herestraat 49, Leuven, Belgium
| | - Efstathios D Pagourelias
- Department of Cardiovascular Sciences, KU Leuven—University of Leuven, Herestraat 49, Leuven, Belgium
- Department of Cardiovascular Diseases, University Hospitals Leuven, Herestraat 49, Leuven, Belgium
| | - Ahmed S Beela
- Department of Cardiovascular Sciences, KU Leuven—University of Leuven, Herestraat 49, Leuven, Belgium
- Department of Cardiovascular Diseases, University Hospitals Leuven, Herestraat 49, Leuven, Belgium
| | - Ganna Degtiarova
- Department of Imaging and Pathology, KU Leuven—University of Leuven, Herestraat 49, Leuven, Belgium
- Department of Nuclear Medicine and Molecular Imaging, University Hospitals Leuven, Herestraat 49, Leuven, Belgium
| | - Kathleen Vunckx
- Department of Imaging and Pathology, KU Leuven—University of Leuven, Herestraat 49, Leuven, Belgium
- Department of Nuclear Medicine and Molecular Imaging, University Hospitals Leuven, Herestraat 49, Leuven, Belgium
| | - Johan Nuyts
- Department of Imaging and Pathology, KU Leuven—University of Leuven, Herestraat 49, Leuven, Belgium
- Department of Nuclear Medicine and Molecular Imaging, University Hospitals Leuven, Herestraat 49, Leuven, Belgium
| | - Walter Coudyzer
- Department of Radiology, University Hospitals Leuven, Herestraat 49, Leuven, Belgium
| | - Piet Claus
- Department of Cardiovascular Sciences, KU Leuven—University of Leuven, Herestraat 49, Leuven, Belgium
- Department of Cardiovascular Diseases, University Hospitals Leuven, Herestraat 49, Leuven, Belgium
| | - Filip Rega
- Department of Cardiovascular Sciences, KU Leuven—University of Leuven, Herestraat 49, Leuven, Belgium
- Department of Cardiothoracic Surgery, University Hospitals Leuven, Herestraat 49, Leuven, Belgium
| | - Olivier Gheysens
- Department of Imaging and Pathology, KU Leuven—University of Leuven, Herestraat 49, Leuven, Belgium
- Department of Nuclear Medicine and Molecular Imaging, University Hospitals Leuven, Herestraat 49, Leuven, Belgium
| | - Jens-Uwe Voigt
- Department of Cardiovascular Sciences, KU Leuven—University of Leuven, Herestraat 49, Leuven, Belgium
- Department of Cardiovascular Diseases, University Hospitals Leuven, Herestraat 49, Leuven, Belgium
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Papillary muscles of left ventricle-Morphological variations and it's clinical relevance. Indian Heart J 2017; 70:894-900. [PMID: 30580862 PMCID: PMC6306352 DOI: 10.1016/j.ihj.2017.12.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 11/21/2017] [Accepted: 12/09/2017] [Indexed: 11/20/2022] Open
Abstract
Introduction The two left ventricular papillary muscles are small structures at sternocostal and inferior wall but are vital to mitral valve competence. Extra papillary muscles could be found. Partial or complete rupture, complicating acute myocardial infarction, causes severe or even catastrophic mitral regurgitation, potentially correctable by surgery. Detailed knowledge of normal anatomy and variations is vital for accurate interpretation of information by echocardiography and for surgical repair. Materials and methods The material for present study consisted of 52 formalin fixed adult apparently normal cadaveric hearts belonging to either sex obtained from the Department of Anatomy. These hearts were dissected carefully to open the left ventricle and to expose the papillary muscles. According to their attitudinal position they were described as supero-lateral (S-L) and inferoseptal muscle (I-S) instead of conventional anterolateral and posteromedial. Different morphological features of papillary muscles were noted and measurements were taken. Results Classical picture of left ventricular papillary muscle was found only in 25% cases. Additionally extra muscles were found 34.61% and 71.15% in S-L and I-S group, respectively. Different shapes and pattern of papillary muscles were also been identified. An additional attribute of this study was measurement of length and breadth of papillary muscles which thus provides a base line data for further detailed studies in a large scale. Conclusion Oriental nomenclature is necessary not only for anatomist but also for electrocardiographers. Breadth of papillay muscle should be taken into morphometric account as for screening of hypertrophic cardiomyopathy. Proper anatomical knowledge is crucial for clinicians, surgeons and radiologists.
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Perrucci GL, Zanobini M, Gripari P, Songia P, Alshaikh B, Tremoli E, Poggio P. Pathophysiology of Aortic Stenosis and Mitral Regurgitation. Compr Physiol 2017. [PMID: 28640443 DOI: 10.1002/cphy.c160020] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The global impact of the spectrum of valve diseases is a crucial, fast-growing, and underrecognized health problem. The most prevalent valve diseases, requiring surgical intervention, are represented by calcific and degenerative processes occurring in heart valves, in particular, aortic and mitral valve. Due to the increasing elderly population, these pathologies will gain weight in the global health burden. The two most common valve diseases are aortic valve stenosis (AVS) and mitral valve regurgitation (MR). AVS is the most commonly encountered valve disease nowadays and affects almost 5% of elderly population. In particular, AVS poses a great challenge due to the multiple comorbidities and frailty of this patient subset. MR is also a common valve pathology and has an estimated prevalence of 3% in the general population, affecting more than 176 million people worldwide. This review will focus on pathophysiological changes in both these valve diseases, starting from the description of the anatomical aspects of normal valve, highlighting all the main cellular and molecular features involved in the pathological progression and cardiac consequences. This review also evaluates the main approaches in clinical management of these valve diseases, taking into account of the main published clinical guidelines. © 2017 American Physiological Society. Compr Physiol 7:799-818, 2017.
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Affiliation(s)
- Gianluca L Perrucci
- Centro Cardiologico Monzino, IRCCS, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | | | | | - Paola Songia
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | | | | | - Paolo Poggio
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
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Kılıcgedik A, Kahveci G, Gurbuz AS, Karabay CY, Guler A, Efe SC, Aung SM, Arslantas U, Demir S, Izgi IA, Kirma C. Papillary Muscle Free Strain in Patients with Severe Degenerative and Functional Mitral Regurgitation. Arq Bras Cardiol 2017; 108:339-346. [PMID: 28538762 PMCID: PMC5421473 DOI: 10.5935/abc.20170035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 10/10/2016] [Accepted: 12/09/2016] [Indexed: 12/16/2022] Open
Abstract
FUNDAMENTO: The role of papillary muscle function in severe mitral regurgitation with preserved and reduced left ventricular ejection fraction and the method of choice to evaluate PM have still been the subjects of controversy. OBJECTIVES: To evaluate and compare papillary muscle function in and between patients with severe degenerative and functional mitral regurgitation by using the free strain method. METHODS: 64 patients with severe mitral regurgitation - 39 patients with degenerative mitral regurgitation (DMR group) and 25 patients with severe functional mitral regurgitation (FMR group) - and 30 control subjects (control group) were included in the study. Papillary muscle function was evaluated through the free strain method from apical four chamber images of the anterolateral papillary muscle (APM) and from apical three chamber images of the posteromedial papillary muscle (PPM). Global left ventricular longitudinal and circumferential strains were evaluated by applying 2D speckle tracking imaging. RESULTS: Global left ventricular longitudinal strain (DMR group, -17 [-14.2/-20]; FMR group, -9 [-7/-10.7]; control group, -20 [-18/-21] p < 0.001), global left ventricular circumferential strain (DMR group, -20 [-14.5/-22.7]; FMR group, -10 [-7/-12]; control group, -23 [-21/-27.5] p < 0.001) and papillary musle strains (PPMS; DMR group, -30.5 [-24/-46.7]; FMR group, -18 [-12/-30]; control group; -43 [-34.5/-39.5] p < 0.001; APMS; DMR group, (-35 [-23.5/-43]; FMR group, -20 [-13.5/-26]; control group, -40 [-32.5/-48] p < 0.001) were significantly different among all groups. APMS and PPMS were highly correlated with LVEF (p < 0.001, p < 0.001; respectively), GLS (p < 0.001, p < 0.001; respectively) and GCS (p < 0.001, p < 0.00; respectively) of LV among all groups. No correlation was found between papillary muscle strains and effective orifice area (EOA) in both groups of severe mitral regurgitation. CONCLUSIONS: Measuring papillary muscle longitudinal strain by the free strain method is practical and applicable. Papillary muscle dysfunction plays a small role in severe MR due to degenerative or functional causes and papillary muscle functions in general seems to follow left ventricular function. PPM is the most affected PM in severe mitral regurgitation in both groups of DMR and FMR. FUNDAMENTO: O papel da função do músculo papilar na regurgitação mitral grave com fração de ejeção do ventrículo esquerdo preservada e reduzida e o método de escolha para avaliar PM ainda são objetos de controvérsia. OBJETIVOS: Avaliar e comparar a função dos músculos papilares entre pacientes com insuficiência mitral funcional e degenerativa pelo método free strain. MÉTODOS: 64 pacientes com insuficiência mitral grave - 39 pacientes com insuficiência mitral degenerativa grave (grupo IMD) e 25 com insuficiência mitral funcional grave (grupo IMF) - e 30 indivíduos controle (grupo controle) foram incluídos no estudo. A função dos músculos papilares foi avaliada pelo método free strain a partir de imagens apicais quatro-câmaras do músculo papilar anterolateral (MPA) e imagens apicais três-câmaras do músculo papilar posteromedial (MPP). Strains circunferenciais e longitudinais globais do ventrículo esquerdo foram avaliados por meio de imagens bidimensionais a partir do rastreamento de conjunto de pontos de cinza (speckle tracking). RESULTADOS: O strain longitudinal global do ventrículo esquerdo (grupo IMD, -17 [-14,2/-20]; grupo IMF, -9 [-7/-10,7]; grupo controle, -20 [-18/-21] p < 0,001); strain circunferencial global do ventrículo esquerdo (grupo IMD, -20 [-14,5/-22,7]; grupo IMF, -10 [-7/-12]; grupo controle, -23 [-21/-27,5] p < 0,001) e strains de músculos papilares (MPP; grupo IMD, -30,5 [-24/-46,7]; grupo IMF, -18 [-12/-30]; grupo controle; -43 [-34,5/-39,5] p < 0,001; MPA; grupo IMD, (-35 [-23,5/-43]; grupo IMF, -20 [-13,5/-26]; grupo controle, -40 [-32,5/-48] p < 0,001) mostraram-se significativamente diferentes nos grupos. MPA e MPP mostraram-se altamente correlacionados com a FEVE (p < 0,001, p < 0,00; respectivamente), SLG (p < 0,001, p < 0,001; respectivamente) e SCG (p < 0,001, p < 0,001; respectivamente) do VE entre todos os grupos. Não foi encontrada correlação entre os strains de músculos papilares e área eficaz do orifício (AEO) nos grupos de insuficiência mitral grave. CONCLUSÕES: A medição do strain longitudinal de músculos papilares pelo método free strain é prática e aplicável. A disfunção dos músculos papilares tem um papel pequeno em IM grave devido a causas degenerativas e funcionais, e a função dos músculos papilares, em general, parece seguir a função ventricular esquerda. O MPP é o MP mais afetado na insuficiência mitral em ambos os grupos, IMD e IMF.
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Affiliation(s)
- Alev Kılıcgedik
- Kartal Koşuyolu Heart & Research Hospital, Department of
Cardiology, Turkey
| | - Gokhan Kahveci
- Kartal Koşuyolu Heart & Research Hospital, Department of
Cardiology, Turkey
| | | | - Can Yucel Karabay
- Kartal Koşuyolu Heart & Research Hospital, Department of
Cardiology, Turkey
| | - Ahmet Guler
- Kartal Koşuyolu Heart & Research Hospital, Department of
Cardiology, Turkey
| | - Suleyman Cagan Efe
- Kartal Koşuyolu Heart & Research Hospital, Department of
Cardiology, Turkey
| | - Soe Moe Aung
- Kartal Koşuyolu Heart & Research Hospital, Department of
Cardiology, Turkey
| | - Ugur Arslantas
- Kartal Koşuyolu Heart & Research Hospital, Department of
Cardiology, Turkey
| | - Serdar Demir
- Kartal Koşuyolu Heart & Research Hospital, Department of
Cardiology, Turkey
| | - Ibrahim Akin Izgi
- Kartal Koşuyolu Heart & Research Hospital, Department of
Cardiology, Turkey
| | - Cevat Kirma
- Kartal Koşuyolu Heart & Research Hospital, Department of
Cardiology, Turkey
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Ivanov A, Bhumireddy GP, Dabiesingh DS, Khan SA, Ho J, Krishna N, Dontineni N, Socolow JA, Briggs WM, Klem I, Sacchi TJ, Heitner JF. Importance of papillary muscle infarction detected by cardiac magnetic resonance imaging in predicting cardiovascular events. Int J Cardiol 2016; 220:558-63. [PMID: 27390987 DOI: 10.1016/j.ijcard.2016.06.201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 05/23/2016] [Accepted: 06/25/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Recent studies suggest that papillary muscle infarction (PMI) following recent myocardial infarction (MI) correlates with adverse cardiovascular outcomes. The purpose of this study is to determine the prevalence and prognostic significance of PMI by cardiac magnetic resonance (CMR) in a large cohort of patients. METHODS Retrospective study of patients who underwent CMR between January 2007 and December 2009 were evaluated for the presence of PMI in one or both of the left ventricle papillary muscles. The primary outcome was a time to a combined endpoint of all-cause mortality and worsening heart failure. Secondary outcomes were time to individual components of the combined outcome. RESULTS 419 patients were included in our analysis, 232 patients (55%) had ischemic cardiomyopathy. Patients were followed at six-month intervals for a median follow-up time of 3.7 (interquartile range (IQR): 1.6; 6.3) years after initial imaging. During this period 196 patients (46.8%) had a primary outcome and 92 patients (22%) died. PM infarct was identified in 204 (48.7%) patients with twice as many posteromedial (PRM) (27%) than anterolateral (ARL) lesions (11%) and a similar number with infarct in both (11%). There was no association between studied outcomes and the presence of PMI in either PRM or ARL PM. The presence of infarct in both PM was a predictor of both the primary outcome (HR 1.69, CI[1.01-2.86], p<0.049.) and mortality (HR 1.69, CI[1.01-4.2], p<0.046). CONCLUSION The presence of infarct in either papillary muscle was not associated with outcomes. However, infarct involving both papillary muscles was associated with worse outcomes.
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Affiliation(s)
- A Ivanov
- Department of Medicine, New York Methodist Hospital, Brooklyn, NY, United States
| | - G P Bhumireddy
- Department of Medicine, New York Methodist Hospital, Brooklyn, NY, United States
| | - D S Dabiesingh
- Department of Medicine, New York Methodist Hospital, Brooklyn, NY, United States
| | - S A Khan
- Department of Medicine, New York Methodist Hospital, Brooklyn, NY, United States
| | - J Ho
- Department of Medicine, New York Methodist Hospital, Brooklyn, NY, United States
| | - N Krishna
- Department of Medicine, New York Methodist Hospital, Brooklyn, NY, United States
| | - N Dontineni
- Department of Medicine, New York Methodist Hospital, Brooklyn, NY, United States
| | - J A Socolow
- Department of Medicine, New York Methodist Hospital, Brooklyn, NY, United States
| | - W M Briggs
- Department of Statistical Sciences, Cornell University, Ithaca, NY, United States
| | - I Klem
- Department of Medicine, Duke University Medical Center, Durham, NC, United States
| | - T J Sacchi
- Department of Medicine, New York Methodist Hospital, Brooklyn, NY, United States
| | - J F Heitner
- Department of Medicine, New York Methodist Hospital, Brooklyn, NY, United States.
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Silbiger JJ. Abnormalities of the Mitral Apparatus in Hypertrophic Cardiomyopathy: Echocardiographic, Pathophysiologic, and Surgical Insights. J Am Soc Echocardiogr 2016; 29:622-39. [DOI: 10.1016/j.echo.2016.03.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2015] [Indexed: 12/30/2022]
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Tuluce SY, Tuluce K, Yuksel A, Yavuzgil O, Cinar CS. Chronic Papillary Muscle Rupture: 14-Year Survival without Surgical Treatment. ACTA CARDIOLOGICA SINICA 2016; 31:172-4. [PMID: 27122867 DOI: 10.6515/acs20140421d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
UNLABELLED Papillary muscle rupture is a life-threatening complication of myocardial infarction which is usually refractory to medical treatment. We present a very rare case of a 65-year-old woman who had a myocardial infarction and posteromedial papillary muscle rupture which was only treated with medical therapy, including her corresponding 14-year follow-up. However, surgical intervention is still strongly recommended because the prognosis of acute papillary muscle rupture associated with myocardial infarction remains poor. KEY WORDS Complication; Myocardial infarction; Papillary muscle rupture; Survival.
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Affiliation(s)
| | - Kamil Tuluce
- Department of Cardiology, Karsiyaka State Hospital
| | | | - Oguz Yavuzgil
- Department of Cardiology, Ege University Faculty of Medicine, Izmir, Turkey
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21
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Li CH, Arzamendi D, Carreras F. Role of Imaging Techniques in Percutaneous Treatment of Mitral Regurgitation. ACTA ACUST UNITED AC 2016; 69:421-36. [PMID: 26926991 DOI: 10.1016/j.rec.2015.12.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Accepted: 12/09/2015] [Indexed: 11/30/2022]
Abstract
Mitral regurgitation is the most prevalent valvular heart disease in the United States and the second most prevalent in Europe. Patients with severe mitral regurgitation have a poor prognosis with medical therapy once they become symptomatic or develop signs of significant cardiac dysfunction. However, as many as half of these patients are inoperable because of advanced age, ventricular dysfunction, or other comorbidities. Studies have shown that surgery increases survival in patients with organic mitral regurgitation due to valve prolapse but has no clinical benefit in those with functional mitral regurgitation. In this scenario, percutaneous repair for mitral regurgitation in native valves provides alternative management of valvular heart disease in patients at high surgical risk. Percutaneous repair for mitral regurgitation is a growing field that relies heavily on imaging techniques to diagnose functional anatomy and guide repair procedures.
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Affiliation(s)
- Chi-Hion Li
- Unidad de Imagen Cardiaca, Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Unidad de Hemodinámica, Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
| | - Dabit Arzamendi
- Unidad de Hemodinámica, Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Francesc Carreras
- Unidad de Imagen Cardiaca, Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
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Maybrook RJ, Afzal MR, Parashar S, Deibert B, Chivington M, Walker JY, Dawn B, Parashara D. Intrinsic and Extrinsic Cardiac Pseudotumors: Echocardiographic Evaluation and Review of the Literature. Echocardiography 2015; 33:117-32. [DOI: 10.1111/echo.13089] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Affiliation(s)
- Ryan J. Maybrook
- Division of Cardiovascular Diseases; University of Kansas Medical Center; Kansas City Kansas
| | - Muhammad R. Afzal
- Division of Cardiovascular Diseases; University of Kansas Medical Center; Kansas City Kansas
| | - Sonya Parashar
- University of Kansas School of Medicine; Kansas City Kansas
| | - Brent Deibert
- University of Kansas School of Medicine; Kansas City Kansas
| | - Mary Chivington
- Division of Cardiovascular Diseases; University of Kansas Medical Center; Kansas City Kansas
| | - Jacquelyn Y. Walker
- Division of Cardiology; VA Eastern Kansas Health Care System; Leavenworth Kansas
| | - Buddhadeb Dawn
- Division of Cardiovascular Diseases; University of Kansas Medical Center; Kansas City Kansas
| | - Deepak Parashara
- Division of Cardiovascular Diseases; University of Kansas Medical Center; Kansas City Kansas
- Division of Cardiology; Kansas City VA Medical Center; Kansas City Missouri
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Abstract
High-level noise and low contrast characteristics in medical images continue to present major bottlenecks in their segmentation despite increased imaging modalities. This paper presents a semi-automatic algorithm that utilizes the noise for enhancing the contrast of low contrast input magnetic resonance images followed by a new graph cut method to reconstruct the surface of left ventricle. The main contribution in this work is a new formulation for preventing the conventional cellular automata method to leak into surrounding regions of similar intensity. Instead of segmenting each slice of a subject sequence individually, we empirically select a few slices, segment them, and reconstruct the left ventricular surface. During the course of surface reconstruction, we use level sets to segment the rest of the slices automatically. We have throughly evaluated the method on both York and MICCAI Grand Challenge workshop databases. The average Dice coefficient (in %) is found to be 92.4 ± 1.3 (value indicates the mean and standard deviation) whereas false positive ratio, false negative ratio, and specificity are found to be 0.019, 7.62 × 10-3, and 0.75, respectively. Average Hausdorff distance between segmented contour and ground truth is determined to be 2.94 mm. The encouraging quantitative and qualitative results reflect the potential of the proposed method.
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Abstract
In the past two decades, major advances have been made in the clinical evaluation and treatment of valvular heart disease owing to the advent of noninvasive cardiac imaging modalities. In clinical practice, valvular disease evaluation is typically performed on two-dimensional (2D) images, even though most imaging modalities offer three-dimensional (3D) volumetric, time-resolved data. Such 3D data offer researchers the possibility to reconstruct the 3D geometry of heart valves at a patient-specific level. When these data are integrated with computational models, native heart valve biomechanical function can be investigated, and preoperative planning tools can be developed. In this review, we outline the advances in valve geometry reconstruction, tissue property modeling, and loading and boundary definitions for the purpose of realistic computational structural analysis of cardiac valve function and intervention.
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Affiliation(s)
- Wei Sun
- Tissue Mechanics Lab, The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Georgia 30313;
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R-R interval variations influence the degree of mitral regurgitation in dogs with myxomatous mitral valve disease. Vet J 2014; 199:348-54. [DOI: 10.1016/j.tvjl.2014.01.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Revised: 12/19/2013] [Accepted: 01/03/2014] [Indexed: 11/21/2022]
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Eitel I, Gehmlich D, Amer O, Wöhrle J, Kerber S, Lauer B, Pauschinger M, Schwab J, Birkemeyer R, Zimmermann R, Mende M, de Waha S, Desch S, Gutberlet M, Schuler G, Thiele H. Prognostic Relevance of Papillary Muscle Infarction in Reperfused Infarction as Visualized by Cardiovascular Magnetic Resonance. Circ Cardiovasc Imaging 2013; 6:890-8. [DOI: 10.1161/circimaging.113.000411] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Ingo Eitel
- From the Department of Internal Medicine/Cardiology (I.E., D.G., O.A., S.d.W., S.D., G.S., H.T.) and Department of Diagnostic and Interventional Radiology (M.G.), University of Leipzig, Heart Center, Leipzig, Germany; Department of Internal Medicine II – Cardiology, University of Ulm, Ulm, Germany (J.W.); Herz- und Gefäß-Klinik Bad Neustadt, Bad Neustadt, Germany (S.K.); Zentralklinik Bad Berka, Bad Berka, Germany (B.L.); Klinikum Nürnberg, Medizinische Klinik/Kardiologie, Nürnberg, Germany (M.P., J
| | - Dörthe Gehmlich
- From the Department of Internal Medicine/Cardiology (I.E., D.G., O.A., S.d.W., S.D., G.S., H.T.) and Department of Diagnostic and Interventional Radiology (M.G.), University of Leipzig, Heart Center, Leipzig, Germany; Department of Internal Medicine II – Cardiology, University of Ulm, Ulm, Germany (J.W.); Herz- und Gefäß-Klinik Bad Neustadt, Bad Neustadt, Germany (S.K.); Zentralklinik Bad Berka, Bad Berka, Germany (B.L.); Klinikum Nürnberg, Medizinische Klinik/Kardiologie, Nürnberg, Germany (M.P., J
| | - Omran Amer
- From the Department of Internal Medicine/Cardiology (I.E., D.G., O.A., S.d.W., S.D., G.S., H.T.) and Department of Diagnostic and Interventional Radiology (M.G.), University of Leipzig, Heart Center, Leipzig, Germany; Department of Internal Medicine II – Cardiology, University of Ulm, Ulm, Germany (J.W.); Herz- und Gefäß-Klinik Bad Neustadt, Bad Neustadt, Germany (S.K.); Zentralklinik Bad Berka, Bad Berka, Germany (B.L.); Klinikum Nürnberg, Medizinische Klinik/Kardiologie, Nürnberg, Germany (M.P., J
| | - Jochen Wöhrle
- From the Department of Internal Medicine/Cardiology (I.E., D.G., O.A., S.d.W., S.D., G.S., H.T.) and Department of Diagnostic and Interventional Radiology (M.G.), University of Leipzig, Heart Center, Leipzig, Germany; Department of Internal Medicine II – Cardiology, University of Ulm, Ulm, Germany (J.W.); Herz- und Gefäß-Klinik Bad Neustadt, Bad Neustadt, Germany (S.K.); Zentralklinik Bad Berka, Bad Berka, Germany (B.L.); Klinikum Nürnberg, Medizinische Klinik/Kardiologie, Nürnberg, Germany (M.P., J
| | - Sebastian Kerber
- From the Department of Internal Medicine/Cardiology (I.E., D.G., O.A., S.d.W., S.D., G.S., H.T.) and Department of Diagnostic and Interventional Radiology (M.G.), University of Leipzig, Heart Center, Leipzig, Germany; Department of Internal Medicine II – Cardiology, University of Ulm, Ulm, Germany (J.W.); Herz- und Gefäß-Klinik Bad Neustadt, Bad Neustadt, Germany (S.K.); Zentralklinik Bad Berka, Bad Berka, Germany (B.L.); Klinikum Nürnberg, Medizinische Klinik/Kardiologie, Nürnberg, Germany (M.P., J
| | - Bernward Lauer
- From the Department of Internal Medicine/Cardiology (I.E., D.G., O.A., S.d.W., S.D., G.S., H.T.) and Department of Diagnostic and Interventional Radiology (M.G.), University of Leipzig, Heart Center, Leipzig, Germany; Department of Internal Medicine II – Cardiology, University of Ulm, Ulm, Germany (J.W.); Herz- und Gefäß-Klinik Bad Neustadt, Bad Neustadt, Germany (S.K.); Zentralklinik Bad Berka, Bad Berka, Germany (B.L.); Klinikum Nürnberg, Medizinische Klinik/Kardiologie, Nürnberg, Germany (M.P., J
| | - Matthias Pauschinger
- From the Department of Internal Medicine/Cardiology (I.E., D.G., O.A., S.d.W., S.D., G.S., H.T.) and Department of Diagnostic and Interventional Radiology (M.G.), University of Leipzig, Heart Center, Leipzig, Germany; Department of Internal Medicine II – Cardiology, University of Ulm, Ulm, Germany (J.W.); Herz- und Gefäß-Klinik Bad Neustadt, Bad Neustadt, Germany (S.K.); Zentralklinik Bad Berka, Bad Berka, Germany (B.L.); Klinikum Nürnberg, Medizinische Klinik/Kardiologie, Nürnberg, Germany (M.P., J
| | - Johannes Schwab
- From the Department of Internal Medicine/Cardiology (I.E., D.G., O.A., S.d.W., S.D., G.S., H.T.) and Department of Diagnostic and Interventional Radiology (M.G.), University of Leipzig, Heart Center, Leipzig, Germany; Department of Internal Medicine II – Cardiology, University of Ulm, Ulm, Germany (J.W.); Herz- und Gefäß-Klinik Bad Neustadt, Bad Neustadt, Germany (S.K.); Zentralklinik Bad Berka, Bad Berka, Germany (B.L.); Klinikum Nürnberg, Medizinische Klinik/Kardiologie, Nürnberg, Germany (M.P., J
| | - Ralf Birkemeyer
- From the Department of Internal Medicine/Cardiology (I.E., D.G., O.A., S.d.W., S.D., G.S., H.T.) and Department of Diagnostic and Interventional Radiology (M.G.), University of Leipzig, Heart Center, Leipzig, Germany; Department of Internal Medicine II – Cardiology, University of Ulm, Ulm, Germany (J.W.); Herz- und Gefäß-Klinik Bad Neustadt, Bad Neustadt, Germany (S.K.); Zentralklinik Bad Berka, Bad Berka, Germany (B.L.); Klinikum Nürnberg, Medizinische Klinik/Kardiologie, Nürnberg, Germany (M.P., J
| | - Rainer Zimmermann
- From the Department of Internal Medicine/Cardiology (I.E., D.G., O.A., S.d.W., S.D., G.S., H.T.) and Department of Diagnostic and Interventional Radiology (M.G.), University of Leipzig, Heart Center, Leipzig, Germany; Department of Internal Medicine II – Cardiology, University of Ulm, Ulm, Germany (J.W.); Herz- und Gefäß-Klinik Bad Neustadt, Bad Neustadt, Germany (S.K.); Zentralklinik Bad Berka, Bad Berka, Germany (B.L.); Klinikum Nürnberg, Medizinische Klinik/Kardiologie, Nürnberg, Germany (M.P., J
| | - Meinhard Mende
- From the Department of Internal Medicine/Cardiology (I.E., D.G., O.A., S.d.W., S.D., G.S., H.T.) and Department of Diagnostic and Interventional Radiology (M.G.), University of Leipzig, Heart Center, Leipzig, Germany; Department of Internal Medicine II – Cardiology, University of Ulm, Ulm, Germany (J.W.); Herz- und Gefäß-Klinik Bad Neustadt, Bad Neustadt, Germany (S.K.); Zentralklinik Bad Berka, Bad Berka, Germany (B.L.); Klinikum Nürnberg, Medizinische Klinik/Kardiologie, Nürnberg, Germany (M.P., J
| | - Suzanne de Waha
- From the Department of Internal Medicine/Cardiology (I.E., D.G., O.A., S.d.W., S.D., G.S., H.T.) and Department of Diagnostic and Interventional Radiology (M.G.), University of Leipzig, Heart Center, Leipzig, Germany; Department of Internal Medicine II – Cardiology, University of Ulm, Ulm, Germany (J.W.); Herz- und Gefäß-Klinik Bad Neustadt, Bad Neustadt, Germany (S.K.); Zentralklinik Bad Berka, Bad Berka, Germany (B.L.); Klinikum Nürnberg, Medizinische Klinik/Kardiologie, Nürnberg, Germany (M.P., J
| | - Steffen Desch
- From the Department of Internal Medicine/Cardiology (I.E., D.G., O.A., S.d.W., S.D., G.S., H.T.) and Department of Diagnostic and Interventional Radiology (M.G.), University of Leipzig, Heart Center, Leipzig, Germany; Department of Internal Medicine II – Cardiology, University of Ulm, Ulm, Germany (J.W.); Herz- und Gefäß-Klinik Bad Neustadt, Bad Neustadt, Germany (S.K.); Zentralklinik Bad Berka, Bad Berka, Germany (B.L.); Klinikum Nürnberg, Medizinische Klinik/Kardiologie, Nürnberg, Germany (M.P., J
| | - Matthias Gutberlet
- From the Department of Internal Medicine/Cardiology (I.E., D.G., O.A., S.d.W., S.D., G.S., H.T.) and Department of Diagnostic and Interventional Radiology (M.G.), University of Leipzig, Heart Center, Leipzig, Germany; Department of Internal Medicine II – Cardiology, University of Ulm, Ulm, Germany (J.W.); Herz- und Gefäß-Klinik Bad Neustadt, Bad Neustadt, Germany (S.K.); Zentralklinik Bad Berka, Bad Berka, Germany (B.L.); Klinikum Nürnberg, Medizinische Klinik/Kardiologie, Nürnberg, Germany (M.P., J
| | - Gerhard Schuler
- From the Department of Internal Medicine/Cardiology (I.E., D.G., O.A., S.d.W., S.D., G.S., H.T.) and Department of Diagnostic and Interventional Radiology (M.G.), University of Leipzig, Heart Center, Leipzig, Germany; Department of Internal Medicine II – Cardiology, University of Ulm, Ulm, Germany (J.W.); Herz- und Gefäß-Klinik Bad Neustadt, Bad Neustadt, Germany (S.K.); Zentralklinik Bad Berka, Bad Berka, Germany (B.L.); Klinikum Nürnberg, Medizinische Klinik/Kardiologie, Nürnberg, Germany (M.P., J
| | - Holger Thiele
- From the Department of Internal Medicine/Cardiology (I.E., D.G., O.A., S.d.W., S.D., G.S., H.T.) and Department of Diagnostic and Interventional Radiology (M.G.), University of Leipzig, Heart Center, Leipzig, Germany; Department of Internal Medicine II – Cardiology, University of Ulm, Ulm, Germany (J.W.); Herz- und Gefäß-Klinik Bad Neustadt, Bad Neustadt, Germany (S.K.); Zentralklinik Bad Berka, Bad Berka, Germany (B.L.); Klinikum Nürnberg, Medizinische Klinik/Kardiologie, Nürnberg, Germany (M.P., J
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SA G, RN W, MS F. Morphological variations of papillary muscles in the mitral valve complex in human cadaveric hearts. Singapore Med J 2013; 54:44-8. [DOI: 10.11622/smedj.2013011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Kim EJ, Song BG, Sohn HR, Hong SM, Park DW, Heo SH, Kim KY, Cho WH, Choi SK. Senile Cardiac Calcification Syndrome: A Rare Case of Extensive Calcification of Left Ventricular Papillary Muscle. Cardiol Res 2011; 2:127-129. [PMID: 28352380 PMCID: PMC5358317 DOI: 10.4021/cr29w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2011] [Indexed: 11/05/2022] Open
Abstract
Extensive papillary muscle calcification is uncommon and only scarce literature about causes and the clinical significance is available, whereas small calcific deposits are common findings in elderly people and are located most commonly at the apex. Papillary muscle calcification has been associated with coronary artery disease, dilated cardiomyopathy, mitral valve disease, hypercalcemia, and increased calcium phosphate product in end stage renal disease. We reported a rare case of extensive calcification of anterolateral papillary muscle diagnosed by echocardiography and multidetector computed tomography.
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Affiliation(s)
- Eun Jin Kim
- Division of Cardiology, Cardiac and Vascular Center, Department of Medicine, Inje University Seoul Paik Hospital, Inje University School of Medicine, Seoul, Korea
| | - Bong Gun Song
- Division of Cardiology, Cardiac and Vascular Center, Department of Medicine, Inje University Seoul Paik Hospital, Inje University School of Medicine, Seoul, Korea
| | - Hyung Rae Sohn
- Division of Cardiology, Cardiac and Vascular Center, Department of Medicine, Inje University Seoul Paik Hospital, Inje University School of Medicine, Seoul, Korea
| | - Su-Min Hong
- Division of Cardiology, Cardiac and Vascular Center, Department of Medicine, Inje University Seoul Paik Hospital, Inje University School of Medicine, Seoul, Korea
| | - Dong Won Park
- Division of Cardiology, Cardiac and Vascular Center, Department of Medicine, Inje University Seoul Paik Hospital, Inje University School of Medicine, Seoul, Korea
| | - Seung Hye Heo
- Division of Cardiology, Cardiac and Vascular Center, Department of Medicine, Inje University Seoul Paik Hospital, Inje University School of Medicine, Seoul, Korea
| | - Kye Yeon Kim
- Division of Cardiology, Cardiac and Vascular Center, Department of Medicine, Inje University Seoul Paik Hospital, Inje University School of Medicine, Seoul, Korea
| | - Wook-Hyun Cho
- Division of Cardiology, Cardiac and Vascular Center, Department of Medicine, Inje University Seoul Paik Hospital, Inje University School of Medicine, Seoul, Korea
| | - Suk-Koo Choi
- Division of Cardiology, Cardiac and Vascular Center, Department of Medicine, Inje University Seoul Paik Hospital, Inje University School of Medicine, Seoul, Korea
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Madu EC, Baugh DS, Tulloch-Reid E, Potu C. Papillary Muscle Function Does Not Predict Mitral Regurgitation in Patients with Normal Left Ventricular Systolic Function: A Transesophageal Echocardiographic Study. ACTA ACUST UNITED AC 2011. [DOI: 10.4236/ijcm.2011.22030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Tanimoto T, Imanishi T, Kitabata H, Nakamura N, Kimura K, Yamano T, Ishibashi K, Komukai K, Ino Y, Takarada S, Kubo T, Hirata K, Mizukoshi M, Tanaka A, Akasaka T. Prevalence and Clinical Significance of Papillary Muscle Infarction Detected by Late Gadolinium-Enhanced Magnetic Resonance Imaging in Patients With ST-Segment Elevation Myocardial Infarction. Circulation 2010; 122:2281-7. [DOI: 10.1161/circulationaha.109.935338] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Takashi Tanimoto
- From the Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Toshio Imanishi
- From the Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Hironori Kitabata
- From the Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Nobuo Nakamura
- From the Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Keizo Kimura
- From the Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Takashi Yamano
- From the Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Kohei Ishibashi
- From the Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Kenichi Komukai
- From the Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Yasushi Ino
- From the Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Shigeho Takarada
- From the Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Takashi Kubo
- From the Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Kumiko Hirata
- From the Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Masato Mizukoshi
- From the Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Atsushi Tanaka
- From the Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Takashi Akasaka
- From the Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
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Ferreira Filho C, Abreu LCD, Valenti VE, Ferreira M, Meneghini A, Silveira JA, Riera ARP, Colombari E, Murad N, Santos-Silva PR, Silva LJHPD, Vanderlei LCM, Carvalho TD, Ferreira C. Anti-hypertensive drugs have different effects on ventricular hypertrophy regression. Clinics (Sao Paulo) 2010; 65:723-8. [PMID: 20668631 PMCID: PMC2910862 DOI: 10.1590/s1807-59322010000700012] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2010] [Revised: 04/06/2010] [Accepted: 04/06/2010] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES There is a direct relationship between the regression of left ventricular hypertrophy (LVH) and a decreased risk of mortality. This investigation aimed to describe the effects of anti-hypertensive drugs on cardiac hypertrophy through a meta-analysis of the literature. METHODS The Medline (via PubMed), Lilacs and Scielo databases were searched using the subject keywords cardiac hypertrophy, antihypertensive and mortality. We aimed to analyze the effect of anti-hypertensive drugs on ventricle hypertrophy. RESULTS The main drugs we described were enalapril, verapamil, nifedipine, indapamina, losartan, angiotensin-converting enzyme inhibitors and atenolol. These drugs are usually used in follow up programs, however, the studies we investigated used different protocols. Enalapril (angiotensin-converting enzyme inhibitor) and verapamil (Ca(++) channel blocker) caused hypertrophy to regress in LVH rats. The effects of enalapril and nifedipine (Ca(++) channel blocker) were similar. Indapamina (diuretic) had a stronger effect than enalapril, and losartan (angiotensin II receptor type 1 (AT1) receptor antagonist) produced better results than atenolol (selective beta1 receptor antagonist) with respect to LVH regression. CONCLUSION The anti-hypertensive drugs induced various degrees of hypertrophic regression.
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Affiliation(s)
- Celso Ferreira Filho
- Departamento de Clínica Médica, Faculdade de Medicina do ABC, Santo André/SP, Brasil.
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Abstract
Anomalies of the mitral subvalvular apparatus can include differing types of papillary muscles and chordae tendinae. Direct insertion of the anomalous papillary muscle or chordae tendinea into the anterior mitral leaflet and fusion to the ventricular septum are common findings related to these anomalies. Anomalous papillary muscles or chordae, especially those that insert directly into the mitral leaflets, play a role in obstructing left ventricular outflow by restricting the mobility of the leaflets and/or tethering them toward the septum, thus narrowing the left ventricular outflow tract (LVOT). The incidence of mitral valve anomalies associated with LVOT is probably underestimated. This topic is frequently studied, however, especially in the pediatric cardiac surgery milieu, because LVOT obstruction could have a surgical solution. We report a case of an 18-year-old woman affected by epilepsy since 5 months of age who was found dead in her bedroom. An uncommon anomalous papillary muscle/chordae was the main autopsy finding. This malformation causes direct continuity between an accessory papillary muscle and a mitral leaflet, resulting in a long rigid area that can cause dynamic late-systolic intraleft-ventricular obstruction. In our case, in the absence of any other pathologic findings or major structural abnormalities, we speculate that a malignant cardiac arrhythmia provoked by the accessory papillary muscle could be the cause of death.
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Jackowski C, Schweitzer W, Thali M, Yen K, Aghayev E, Sonnenschein M, Vock P, Dirnhofer R. Virtopsy: postmortem imaging of the human heart in situ using MSCT and MRI. Forensic Sci Int 2005; 149:11-23. [PMID: 15734105 DOI: 10.1016/j.forsciint.2004.05.019] [Citation(s) in RCA: 94] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2004] [Accepted: 05/31/2004] [Indexed: 10/26/2022]
Abstract
The rapid further development of computed tomography (CT) and magnetic resonance imaging (MRI) induced the idea to use these techniques for postmortem documentation of forensic findings. Until now, only a few institutes of forensic medicine have acquired experience in postmortem cross-sectional imaging. Protocols, image interpretation and visualization have to be adapted to the postmortem conditions. Especially, postmortem alterations, such as putrefaction and livores, different temperature of the corpse and the loss of the circulation are a challenge for the imaging process and interpretation. Advantages of postmortem imaging are the higher exposure and resolution available in CT when there is no concern for biologic effects of ionizing radiation, and the lack of cardiac motion artifacts during scanning. CT and MRI may become useful tools for postmortem documentation in forensic medicine. In Bern, 80 human corpses underwent postmortem imaging by CT and MRI prior to traditional autopsy until the month of August 2003. Here, we describe the imaging appearance of postmortem alterations--internal livores, putrefaction, postmortem clotting--and distinguish them from the forensic findings of the heart, such as calcification, endocarditis, myocardial infarction, myocardial scarring, injury and other morphological alterations.
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Affiliation(s)
- Christian Jackowski
- Institute of Forensic Medicine, University of Bern, IRM-Buehlstrasse 20, CH-3012 Bern, Switzerland.
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Abstract
PURPOSE Conventional nuclear medicine equipment lacks sufficient spatial resolution to reliably visualize the papillary muscles (PM). Positron emission tomography (PET), however, can adequately visualize these structures using various positron emitters. METHODS AND PATIENTS We present various patterns of PM observed on myocardial PET imaging in 4 patients. These patterns demonstrate different pathologic conditions such as PM ischemia of varying severity, as well as hibernation, using both N-13 NH3 and F-18 FDG as perfusion and metabolic agents, respectively. These patterns of infarction, stress-induced myocardial ischemia, or hibernation can be identified in one or both PM using PET scanning. Normal PM visualization on chest F-18 FDG PET images is also presented. CONCLUSION This report illustrates the potential ability of myocardial PET as a noninvasive modality to study the perfusion and metabolic abnormalities of the PM.
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Affiliation(s)
- Adam P Steinmetz
- Department of Nuclear Medicine, Rabin Medical Center, Beilinson Campus, Petach-Tikva, Israel.
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Alizad A, Fatemi M, Nishimura RA, Kinnick RR, Rambod E, Greenleaf JF. Detection of calcium deposits on heart valve leaflets by vibro-acoustography: an in vitro study. J Am Soc Echocardiogr 2002; 15:1391-5. [PMID: 12415234 DOI: 10.1067/mje.2002.124985] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The presence of calcium deposits on heart valve leaflets constitutes a clinically significant diagnostic indication. A novel method for imaging and detecting calcium deposits on tissue heart valves is presented. The method, called vibro-acoustography, uses the radiation force of ultrasound to vibrate the tissue at low (kHz) frequency and records the resulting acoustic response to produce images that are related to the hardness of the tissue. The method is tested on excised human heart valve tissues. Resulting images clearly show calcium deposits with high contrast and are in agreement with the corresponding radiographs of the specimens.
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Affiliation(s)
- Azra Alizad
- Basic Ultrasound Research, Department of Physiology and Biophysics, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905, USA.
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Abstract
Extensive papillary muscle calcification is quite a rare finding in echocardiographic examinations. A case of a 71 year old man with isolated calcification of the papillary muscles, detected by fluoroscopy and confirmed by echocardiography, is presented. Intracardiac calcifications in patients with prior right coronary artery occlusion and mitral regurgitation should suggest the possibility of posteromedial papillary muscle calcification and dysfunction.
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Affiliation(s)
- F T Schwender
- Henry Ford Hospital, Department of Internal Medicine, 2799 West Grand Boulevard, Detroit, MI 48202, USA
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Roul G, Sens P, Germain P, Bareiss P. Myocardial bridging as a cause of acute transient left heart dysfunction. Chest 1999; 116:574-80. [PMID: 10453894 DOI: 10.1378/chest.116.2.574] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
The significance of myocardial bridging is still a matter of debate, and although several reports have underlined its pathologic potential, myocardial bridging is often considered to be a benign phenomenon. We present here the case of a 63-year-old woman with a history of acute left heart failure and ECG evidence of ischemia, and whose primary abnormality on extensive workup was myocardial bridging. This case further underlines that myocardial bridging can lead to significant cardiac events.
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Affiliation(s)
- G Roul
- Cardiology Department, Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre, France.
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Heuser RR. The right place, the right time. Catheter Cardiovasc Interv 1999; 46:450-1. [PMID: 10216014 DOI: 10.1002/(sici)1522-726x(199904)46:4<450::aid-ccd14>3.0.co;2-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Abstract
Chronic mitral regurgitation is a progressive disorder that can produce myocardial dysfunction in the absence of symptoms. Improvements in surgical techniques have resulted in earlier intervention, at times in asymptomatic patients. This article discusses the factors that influence prognosis, reviews the evidence supporting earlier intervention and provides guidelines for the management of patients with this lesion.
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Affiliation(s)
- M A Quiñones
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
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42
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Letters to the editor. Clin Cardiol 1997. [DOI: 10.1002/clc.4960200523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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