Predictors of Moderate to Severe Ischemic Mitral Regurgitation After Myocardial Infarction: a Cardiac Magnetic Resonance Study

Overview

Journal Eur Radiol

Specialty Radiology

Date 2021 Jan 15

PMID 33449179

Citations 5

Authors

Chen Zhang

Lei Zhao

Enjun Zhu

Paul Schoenhagen

Jie Tian

Yong-Qiang Lai

Xiaohai Ma

Affiliations

Soon will be listed here.

Abstract

Objectives: The purpose of this study is to explore the predictors of moderate to severe ischemic mitral regurgitation (IMR) after myocardial infarction with cardiovascular magnetic resonance (CMR).

Methods: From January 2016 to September 2018, 109 patients (mean age 60 ± 8 years) with IMR were studied retrospectively. All patients underwent CMR-cine with True-FISP sequence and late gadolinium enhancement (LGE) with a phase-sensitive inversion recovery sequence. The presence of papillary muscle infarction (PMI), global left ventricular (LV) infarcted extent, LV functional parameters, and LV myocardial strain were assessed. Univariate and multivariate analyses were performed to identify factors in the development of moderate to severe IMR.

Results: Mild IMR was present in 61 patients (56%), and moderate to severe IMR was present in 48 patients (44%). PMI was identified in 22 patients (20.1%); 14 of them (63.63%) showed a moderate or severe IMR. Global LV infarcted extent was increased in patients with moderate to severe IMR (p < 0.001). LV functional parameters of patients with moderate to severe IMR were statistically different from those of the patients with mild IMR (all p < 0.001), except the LV SV index (p = 0.142) and LV CI (p = 0.447). The global longitudinal strain (GLS), regional radial strain (RS), and circumferential strain (CS) of the moderate-to-severe IMR group were significantly decreased compared with those of the mild IMR group (p < 0.05). In multivariable analyses, age (OR = 1.11; p = 0.001), global LV infarct extent (OR = 1.14; p = 0.000), and GLS (OR = 1.31; p = 0.000) were associated with moderate-to-severe chronic IMR.

Conclusions: The incidence of PMI was higher in patients with moderate-to-severe IMR. The extent of global LV infarcted extent and GLS were independent predictors of moderate-to-severe IMR.

Key Points: • Cardiovascular magnetic resonance late gadolinium enhancement and feature-tracking imaging provide reliable information on LV function, myocardial viability, and papillary muscle morphology. • Papillary muscle infarction is not an independent predictor of moderate-to-severe IMR. • The extent of global LV infarction and LV global longitudinal strain were independent predictors of moderate-to-severe chronic IMR.

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References

Kumanohoso T, Otsuji Y, Yoshifuku S, Matsukida K, Koriyama C, Kisanuki A . Mechanism of higher incidence of ischemic mitral regurgitation in patients with inferior myocardial infarction: quantitative analysis of left ventricular and mitral valve geometry in 103 patients with prior myocardial infarction. J Thorac Cardiovasc Surg. 2003; 125(1):135-43. DOI: 10.1067/mtc.2003.78. View

Bursi F, Enriquez-Sarano M, Nkomo V, Jacobsen S, Weston S, Meverden R . Heart failure and death after myocardial infarction in the community: the emerging role of mitral regurgitation. Circulation. 2005; 111(3):295-301. DOI: 10.1161/01.CIR.0000151097.30779.04. View

de Canniere D, Vandenbossche J, Nouar E, Faict S, Falchetti A, Unger P . Clinical Implications of Preserving Subvalvular Apparatus During Mitral Valve Replacement for Acute Ischemic Papillary Muscle Rupture. Ann Thorac Surg. 2016; 102(1):305-8. DOI: 10.1016/j.athoracsur.2015.06.121. View

Eitel I, Gehmlich D, Amer O, Wohrle J, Kerber S, Lauer B . Prognostic relevance of papillary muscle infarction in reperfused infarction as visualized by cardiovascular magnetic resonance. Circ Cardiovasc Imaging. 2013; 6(6):890-8. DOI: 10.1161/CIRCIMAGING.113.000411. View

Nishimura R, Otto C, Bonow R, Carabello B, Erwin 3rd J, Fleisher L . 2017 AHA/ACC Focused Update of the 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2017; 70(2):252-289. DOI: 10.1016/j.jacc.2017.03.011. View

Bretschneider C, Heinrich H, Seeger A, Burgstahler C, Miller S, Kramer U . Impact of Papillary Muscle Infarction on Ischemic Mitral Regurgitation Assessed by Magnetic Resonance Imaging. Rofo. 2017; 190(1):42-50. DOI: 10.1055/s-0043-115121. View

Lancellotti P, Tribouilloy C, Hagendorff A, Popescu B, Edvardsen T, Pierard L . Recommendations for the echocardiographic assessment of native valvular regurgitation: an executive summary from the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2013; 14(7):611-44. DOI: 10.1093/ehjci/jet105. View

Cerqueira M, Weissman N, Dilsizian V, Jacobs A, Kaul S, Laskey W . Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart. A statement for healthcare professionals from the Cardiac Imaging Committee of the Council on Clinical Cardiology of the American Heart Association. Circulation. 2002; 105(4):539-42. DOI: 10.1161/hc0402.102975. View

Roberts W, Cohen L . Left ventricular papillary muscles. Description of the normal and a survey of conditions causing them to be abnormal. Circulation. 1972; 46(1):138-54. DOI: 10.1161/01.cir.46.1.138. View

10.

Grigioni F, Enriquez-Sarano M, Zehr K, Bailey K, Tajik A . Ischemic mitral regurgitation: long-term outcome and prognostic implications with quantitative Doppler assessment. Circulation. 2001; 103(13):1759-64. DOI: 10.1161/01.cir.103.13.1759. View

11.

Grigioni F, Detaint D, Avierinos J, Scott C, Tajik J, Enriquez-Sarano M . Contribution of ischemic mitral regurgitation to congestive heart failure after myocardial infarction. J Am Coll Cardiol. 2005; 45(2):260-7. DOI: 10.1016/j.jacc.2004.10.030. View

12.

Mihaljevic T, Lam B, Rajeswaran J, Takagaki M, Lauer M, Gillinov A . Impact of mitral valve annuloplasty combined with revascularization in patients with functional ischemic mitral regurgitation. J Am Coll Cardiol. 2007; 49(22):2191-201. DOI: 10.1016/j.jacc.2007.02.043. View

13.

Penicka M, Linkova H, Lang O, Fojt R, Kocka V, Vanderheyden M . Predictors of improvement of unrepaired moderate ischemic mitral regurgitation in patients undergoing elective isolated coronary artery bypass graft surgery. Circulation. 2009; 120(15):1474-81. DOI: 10.1161/CIRCULATIONAHA.108.842104. View

14.

Podlesnikar T, Delgado V, Bax J . Cardiovascular magnetic resonance imaging to assess myocardial fibrosis in valvular heart disease. Int J Cardiovasc Imaging. 2017; 34(1):97-112. PMC: 5797565. DOI: 10.1007/s10554-017-1195-y. View

15.

Chinitz J, Chen D, Goyal P, Wilson S, Islam F, Nguyen T . Mitral apparatus assessment by delayed enhancement CMR: relative impact of infarct distribution on mitral regurgitation. JACC Cardiovasc Imaging. 2013; 6(2):220-34. PMC: 4048744. DOI: 10.1016/j.jcmg.2012.08.016. View

16.

Zhu D, Ito S, Miranda W, Nkomo V, Pislaru S, Villarraga H . Left Ventricular Global Longitudinal Strain Is Associated With Long-Term Outcomes in Moderate Aortic Stenosis. Circ Cardiovasc Imaging. 2020; 13(4):e009958. DOI: 10.1161/CIRCIMAGING.119.009958. View

17.

Kim H, Cho G, Hwang I, Choi H, Park J, Yoon Y . Myocardial Strain in Prediction of Outcomes After Surgery for Severe Mitral Regurgitation. JACC Cardiovasc Imaging. 2018; 11(9):1235-1244. DOI: 10.1016/j.jcmg.2018.03.016. View

18.

Lakatos B, Kovacs A . Global Longitudinal Strain in Moderate Aortic Stenosis: A Chance to Synthesize It All?. Circ Cardiovasc Imaging. 2020; 13(4):e010711. DOI: 10.1161/CIRCIMAGING.120.010711. View

19.

Atici A, Barman H, Durmaz E, Demir K, Cakmak R, Tugrul S . Predictive value of global and territorial longitudinal strain imaging in detecting significant coronary artery disease in patients with myocardial infarction without persistent ST-segment elevation. Echocardiography. 2019; 36(3):512-520. DOI: 10.1111/echo.14275. View

20.

Donal E, Bergerot C, Thibault H, Ernande L, Loufoua J, Augeul L . Influence of afterload on left ventricular radial and longitudinal systolic functions: a two-dimensional strain imaging study. Eur J Echocardiogr. 2009; 10(8):914-21. DOI: 10.1093/ejechocard/jep095. View