J Cardiovasc Imaging.  2021 Jan;29(1):46-56. 10.4250/jcvi.2020.0112.

The Role of False Tendons in Left Ventricular Remodeling and Secondary Mitral Regurgitation After Acute Myocardial Infarction

• Presti SL
• Baruqui DL
• Perez J
• Vadasseril BJ
• Escolar E
• Horvath SA
• Mihos CG

• KMID: 2512380
• DOI: http://doi.org/10.4250/jcvi.2020.0112

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 χ 2 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/m 2 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 postmyocardial infarction.

Keyword

Left ventricular false tendons; Left ventricular remodeling; Myocardial infarction; Ischemic mitral regurgitation; Echocardiography