The importance of papillary muscle dyssynchrony in predicting the severity of functional mitral regurgitation in patients with non-ischaemic dilated cardiomyopathy: A two-dimensional speckle-tracking echocardiography study


Tigen K. , Karaahmet T., Dundar C., Guler A., Cevik C., Basaran O., ...More

European Journal of Echocardiography, vol.11, no.8, pp.671-676, 2010 (Journal Indexed in SCI Expanded) identifier identifier identifier

  • Publication Type: Article / Article
  • Volume: 11 Issue: 8
  • Publication Date: 2010
  • Doi Number: 10.1093/ejechocard/jeq040
  • Title of Journal : European Journal of Echocardiography
  • Page Numbers: pp.671-676
  • Keywords: Dilated cardiomyopathy, Mitral regurgitation, Papillary muscle dyssynchrony

Abstract

Aims: In our study, we investigated the impact of papillary muscle systolic dyssynchrony (DYS-PAP) and the configuration of mitral leaflets in the prediction of significant functional mitral regurgitation (MR) with two-dimensional (2D) speckle-tracking strain analysis in non-ischaemic dilated cardiomyopathy (DCM) patients with sinus rhythm.MethodsThirty-six non-ischaemic DCM patients (left ventricular ejection fraction <40) with sinus rhythm were recruited. The quantification of functional MR was performed using the proximal isovelocity surface area method. The configuration of mitral leaflets [mitral annulus, coaptation height (CH), and tethering distances for papillary muscles] was evaluated in the parasternal long-axis and apical four-chamber views. The assessment of DYS-PAP was performed by applying 2D speckle-tracking imaging to the apical four-chamber view for anterolateral papillary muscle and to the apical long-axis view for posteromedial papillary muscle.ResultsFifteen (41.6) patients had mild MR and 21 (58.3) patients had moderate or moderate-to-severe MR. Patients with higher levels of MR had larger mitral annulus size (P = 0.02), tethering-AL (P = 0.04), higher MR volume (P < 0.0001), effective regurgitant orifice area (P < 0.0001), and DYS-PAP (P < 0.0001) values, but lower CH (P = 0.001), global longitudinal (P = 0.005), radial (P = 0.03), and circumferential strain (P = 0.01) than those with mild MR. Receiver operating characteristic analysis was performed to assess the utility of DYS-PAP to predict moderate or moderate-to-severe functional MR. A DYS-PAP value >30 ms predicted moderate-to-severe MR with 85 sensitivity and 87 specificity [area under the curve: 0.897, 95 confidence interval (CI): 0.781-0.999, P < 0.0001]. Logistic regression analysis revealed that DYS-PAP (odds ratio: 3.2, 95 CI: 1.22-47.7, P = 0.037) was the only independent predictor of moderate or moderate-to-severe functional MR.Conclusion: DYS-PAP is correlated with functional MR in non-ischaemic DCM patients with sinus rhythm. A DYS-PAP cut-off value of 30 ms is a useful tool to identify patients with moderate-to-severe functional MR. © 2010 The Author.