The Role of False Tendons in Left Ventricular Remodeling and Secondary Mitral Regurgitation After Acute Myocardial Infarction
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BACKGROUND: Left ventricular false tendons (LVFT) are common structures visualized on transthoracic echocardiography (TTE). The present study tested the hypothesis that LVFT, via a possible ‘constraint’ mechanism, attenuate left ventricular (LV) remodeling and secondary mitral regurgitation after acute myocardial infarction. METHODS: Seventy-one patients admitted to the Coronary Care Unit following an ST-elevation (n = 63) or non-ST-elevation (n = 8) myocardial infarction were analyzed; 29 (41%) had LVFT, and 42 (59%) did not (no-LVFT). All had a TTE and at least 1 follow-up study after revascularization. The χ2 analysis, Student's t-test, and Mann Whitney U test were used for the statistical analyses. RESULTS: The mean age (64 vs. 66 years), left ventricular ejection fraction (LVEF) (41% vs. 39%), left ventricular end-diastolic diameter (LVEDd) index (23 mm/m2 for both), and prevalence of ≥ moderate secondary/functional mitral regurgitation (MR) (17% vs. 14%) were similar between the LVFT and no-LVFT groups. At 1-year follow-up, there was no significant difference in chamber remodeling amongst the LVFT versus no-LVFT group when assessed by: 1) ≥ 10% decrease in the relative LVEF (24% vs. 26%; p = 0.83); 2) ≥ 10% increase in the LVEDd index (41% vs. 38%, p = 0.98); and, 3) ≥ 10% increase in the LV mass index (48% vs. 41%, p = 0.68). There was no difference in the prevalence of ≥ moderate secondary/functional MR (17% vs. 12%, p = 0.77). Outcomes remained similar when stratifying by LVFT morphology or ischemic territory. CONCLUSIONS: In patients with mild to moderate LV dysfunction and normal chamber size, LVFT do not affect the development of LV remodeling or secondary/functional MR post-myocardial infarction.
Abstract
BACKGROUND: Left ventricular false tendons (LVFT) are common structures visualized on transthoracic echocardiography (TTE). The present study tested the hypothesis that LVFT, via a possible ‘constraint’ mechanism, attenuate left ventricular (LV) remodeling and secondary mitral regurgitation after acute myocardial infarction. METHODS: Seventy-one patients admitted to the Coronary Care Unit following an ST-elevation (n = 63) or non-ST-elevation (n = 8) myocardial infarction were analyzed; 29 (41%) had LVFT, and 42 (59%) did not (no-LVFT). All had a TTE and at least 1 follow-up study after revascularization. The χ2 analysis, Student's t-test, and Mann Whitney U test were used for the statistical analyses. RESULTS: The mean age (64 vs. 66 years), left ventricular ejection fraction (LVEF) (41% vs. 39%), left ventricular end-diastolic diameter (LVEDd) index (23 mm/m2 for both), and prevalence of ≥ moderate secondary/functional mitral regurgitation (MR) (17% vs. 14%) were similar between the LVFT and no-LVFT groups. At 1-year follow-up, there was no significant difference in chamber remodeling amongst the LVFT versus no-LVFT group when assessed by: 1) ≥ 10% decrease in the relative LVEF (24% vs. 26%; p = 0.83); 2) ≥ 10% increase in the LVEDd index (41% vs. 38%, p = 0.98); and, 3) ≥ 10% increase in the LV mass index (48% vs. 41%, p = 0.68). There was no difference in the prevalence of ≥ moderate secondary/functional MR (17% vs. 12%, p = 0.77). Outcomes remained similar when stratifying by LVFT morphology or ischemic territory. CONCLUSIONS: In patients with mild to moderate LV dysfunction and normal chamber size, LVFT do not affect the development of LV remodeling or secondary/functional MR post-myocardial infarction.
참고문헌 (25)
- Turner W, "A human heart with moderator bands in the left ventricle", J Anat Physiol, 27, pp.19~20 (1893)
- Nishimura T, "Echocardiographic features of the false tendons in the left ventricle", Am J Cardiol, 48, pp.177~183 (1981)
- Perry LW, "Left ventricular false tendons in children : prevalence as detected by 2-dimensional echocardiography and clinical significance", Am J Cardiol, 52, pp.1264~1266 (1983)
- Vered Z, "Prevalence and significance of false tendons in the left ventricle as determined by echocardiography", Am J Cardiol, 53, pp.330~332 (1984)
- Brenner JI, "Echocardiographic evidence of left ventricular bands in infants and children", J Am Coll Cardiol, 3, pp.1515~1520 (1984)
- Luetmer PH, "Incidence and distribution of left ventricular false tendons : an autopsy study of 483 normal human hearts", J Am Coll Cardiol, 8, pp.179~183 (1986)
- Malouf J, "A reappraisal of the prevalence and clinical importance of left ventricular false tendons in children and adults", Br Heart J, 55, pp.587~591 (1986)
- Abdulla AK, "Echocardiography and pathology of left ventricular"false tendons"", Chest, 98, pp.129~132 (1990)
- Silbiger JJ, "Left ventricular false tendons: anatomic, echocardiographic, and pathophysiologic insights", J Am Soc Echocardiogr, 26, pp.582~588 (2013)
- Bhatt MR, "Effects and mechanisms of left ventricular false tendons on functional mitral regurgitation in patients with severe cardiomyopathy", J Thorac Cardiovasc Surg, 138, pp.1123~1128 (2009)
- Loukas M, "False tendons : an endoscopic cadaveric approach", Clin Anat, 20, pp.163~169 (2007)
- O'Gara PT, "2013 ACCF", AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation, J Am Coll Cardiol, pp.2013, 61[DOI]
- Amsterdam EA, "2014 AHA", ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes: a report of the American College of Cardiology, J Am Coll Cardiol, pp.2014, 64[DOI]
- Lang RM, "Recommendations for cardiac chamber quantification by echocardiography in adults : an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging", Eur Heart J Cardiovasc Imaging, 16, pp.233~270 (2015)
- Zoghbi WA, "Recommendations for noninvasive evaluation of native valvular regurgitation : a report from the American Society of Echocardiography Developed in collaboration with the Society for Cardiovascular Magnetic Resonance", J Am Soc Echocardiogr, 30, pp.303~371 (2017)
- Godley RW, "Incomplete mitral leaflet closure in patients with papillary muscle dysfunction", Circulation, 63, pp.565~571 (1981)
- Mihos CG, "The effects of cardiac resynchronization therapy on left ventricular and mitral valve geometry and secondary mitral regurgitation in patients with left bundle branch block", Echocardiography, 36, pp.1450~1458 (2019)
- Konstam MA, "Left ventricular remodeling in heart failure : current concepts in clinical significance and assessment", JACC Cardiovasc Imaging, 4, pp.98~108 (2011)
- Kenchaiah S, "Epidemiology of left ventricular false tendons : clinical correlates in the Framingham Heart Study", J Am Soc Echocardiogr, 22, pp.739~745 (2009)
- Mihos CG, "Impact of cardiac resynchronization therapy on mitral valve apparatus geometry and clinical outcomes in patients with secondary mitral regurgitation", Echocardiography, 34, pp.1561~1567 (2017)
- Nappi F, "Functional mitral regurgitation : an overview for surgical management framework", J Thorac Dis, 10, pp.4540~4555 (2018)
- Toshimori H, "The distribution of atrial natriuretic polypeptide(ANP)-containing cells in the adult rat heart", Anat Embryol(Berl), 177, pp.477~484 (1988)
- Redondo J, "Effect of atrial natriuretic peptide and cyclic GMP phosphodiesterase inhibition on collagen synthesis by adult cardiac fibroblasts", Br J Pharmacol, 124, pp.1455~1462 (1998)
- Hayashi M, "Intravenous atrial natriuretic peptide prevents left ventricular remodeling in patients with first anterior acute myocardial infarction", J Am Coll Cardiol, 37, pp.1820~1826 (2001)
- Nagasaki M, "The echocardiographic determinants of functional mitral regurgitation differ in ischemic and non-ischemic cardiomyopathy", Int J Cardiol, 108, pp.171~176 (2006)