Systolic papillary muscle dyssynchrony predicts recurrence of mitral regurgitation in patients with ischemic cardiomyopathy (ICM) undergoing mitral valve repair.

Objective: We investigated the impact of papillary muscle dyssynchrony (DYS-PAP) in predicting recurrent mitral regurgitation (MR) in patients with ischemic cardiomyopathy (ICM) undergoing undersized mitral ring annuloplasty (UMRA). Methods: One hundred forty-four ICM patients (left ventricular ejection fraction <35%) in sinus rhythm undergoing UMRA between January 2001 and December 2010 at three Institutions (University Hospital, Maastricht, The Netherlands; Careggi Hospital, Florence, Italy; Civic Hospital, Brescia, Italy) were recruited. The primary endpoint was the recurrence of MR at the latest echocardiographic study defined as insufficiency 2+ in patients with no/trivial MR at discharge. The assessment of DYS-PAP was performed by applying two-dimensional (2D) speckle-tracking imaging. Results: In patients with MR recurrence, DYS-PAP significantly worsened (84.1 ± 8.8 msec vs.65.4 ± 8.8 msec at baseline, P < 0.001) whereas in patients with no MR recurrence, DYS-PAP did not vary (22.3 ± 5.3 msec vs. 25.9 ± 7.2 msec at baseline, P = 0.8). Recurrent MR was positively correlated with preoperative DYS-PAP (P < 0.001), baseline anterior mitral leaflet tethering angle a (P < 0.001) and tethering symmetry index a/b before surgery (P < 0.001). There was no significant correlation between MR recurrence and other echocardiographic parameters. Logistic regression analysis revealed that baseline values of DYS-PAP (OR: 5.4 [95% CI: 3.1–7.7], P < 0.001), a (OR: 5.0 [2.6– 6.7], P < 0.001), and a/b (OR: 3.9 [2.5–5.7], p < 0.001) were predictors of recurrent MR. A DYS-PAP value 58 msec predicted recurrence of MR with 100% sensitivity and 83% specificity (area under the curve [AUC]: 0.92 [0.7–1], P < 0.001). Conclusions: A DYS-PAP cutoff value of 58 msec is useful to identify patients in whom UMRA is likely to fail. That way decision making in ischemic functional MR might be facilitated. (Echocardiography 2012;29:1191-1200)