P1030Papillary muscle asynchrony - how useful can it be in the assessment of patients with severe chronic heart failure?

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Background: Papillary muscles (PM) asynchrony is among the crucial mechanisms leading to mitral valve regurgitation (MR) and can worsen prognosis in patients with severe heart failure. It has not been established yet how to quantify PM function. The purpose of this study was to find a potential relationship between the level of PM asynchrony and the degree of MR in patients with ischemic and nonischemic cardiomyopathies (ICM and nICM, respectively).Methods: 21 ICM and 10 nICM patients with EF ≤ 35%, NYHA ≥ III/IV and sinus rhythm were enrolled in the study. The parameters describing the degree of MR (vena contracta, EROA, MR jet area, left atrial area [LAA], MR ratio, left atrial dimensions) and the deformation of mitral apparatus (mitral tenting area) and PM function (the amount of deformation, PM asynchrony) were obtained using standard echocardiography and tissue Doppler imaging, respectively. The difference of 65 ms and more in time to peak strain ([Latin Small Letter Open E]) between antero-lateral and postero-medial PM was considered indicative of PM asynchrony.Results: PM asynchrony was discovered in 15 out of 31 patients (10 with ICM – 47,6% and 5 with nICM - 50%). PM asynchrony correlated with mitral tenting area and left atrial area - respectively; r=0.42, p=0.03, and r=0.57, p=0.001. The correlation between nICM PM asynchrony and nICM LAA was stronger (r=0.80, p=0.02) and far exceeded the one observed for ICM pts (r=0.54, p=0.01). The relationship between the PM asynchrony and the remainder of the indices characterizing the degree of MR was weak.Conclusions: Papillary muscles asynchrony did not reflect the degree of MR but seems to be associated with the deformation of mitral apparatus measured by tenting area. The level of haemodynamic consequences of MR can be better characterized by PM asynchrony in nICM than in ICM patients.

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