Acute Effects of Initiation and Withdrawal of Cardiac Resynchronization Therapy on Papillary Muscle Dyssynchrony and Mitral Regurgitation
Claudia Ypenburg, MD*,
Patrizio Lancellotti, MD, PhD ,
Laurens F. Tops, MD*,
Gabe B. Bleeker, MD*,
Eduard R. Holman, MD, PhD*,
Luc A. Piérard, MD, PhD,
Martin J. Schalij, MD, PhD* and
Jeroen J. Bax, MD, PhD*,*
* Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
Department of Cardiology, University Hospital Sart Tilman, Liege, Belgium
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Figure 1 Example of Position of the Papillary Muscles
Short-axis view of the left ventricle (LV) at the level of the papillary muscles, with reconstruction of the 6 LV segments. In this patient, the anterior papillary muscle (APM) was located adjacent to the lateral LV segment (green) and the posterior papillary muscle (PPM) was located adjacent to the inferior LV segment (dark blue).
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Figure 2 Position of the Papillary Muscles
The anterior papillary muscle (APM) was located adjacent to the lateral (LAT) left ventricular (LV) segment in 18 patients (72%) and adjacent to the anterior (ANT) LV segment in 7 patients (28%); the posterior papillary muscle (PPM) was located adjacent to the inferior (INF) LV segment in 22 patients (88%) and adjacent to the posterior (POST) LV segment in 3 patients (12%).
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Figure 3 Severity of Mitral Regurgitation After CRT
Severity of mitral regurgitation (expressed in mean vena contracta width) at baseline (PRE), immediately after CRT implantation (POST), at 6 months' follow-up (6 MO), and during interruption of CRT at 6 months (OFF). CRT = cardiac resynchronization therapy.
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Figure 4 Patient Example
Time-strain curves of the 6 left ventricle (LV) segments at the level of the papillary muscles. (A) At baseline, the delay between peak radial strain of the anterior papillary muscle (adjacent to the lateral LV segment; green curve) and the posterior papillary muscle (adjacent to the inferior LV segment; dark blue curve) was 180 ms. (B) After initiation of CRT, the dyssynchrony between the papillary muscles disappeared.
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