Prognostic Relevance and Clinical Features of Papillary Muscle Infarction with Mitral Regurgitation in Patients with ST Segment Elevation Myocardial Infarction

Overview

Journal J Thorac Dis

Publisher AME Publishing Company

Specialty Pulmonary Medicine

Date 2021 Feb 11

PMID 33569213

Citations 4

Authors

Dazhou Lei

Jun Xie

Qing Dai

Yinhao Huang

Xuan Wei

Dan Mu

Xue Bao

Jianhui Li

Biao Xu

Affiliations

Soon will be listed here.

Abstract

Background: Papillary muscle infarction (PapMI) combined with mitral regurgitation (MR) is a severe complication of ST-segment elevation myocardial infarction (STEMI). The features detected by cardiac magnetic resonance (CMR) imaging in PapMI have not been characterized. The aim of the present study was to assess the incidence, determinants, and the prognostic significance of PapMI with MR at 1-year follow-up in a study of patients with STEMI after primary percutaneous coronary intervention (pPCI).

Methods: We enrolled 209 patients with STEMI reperfused by pPCI (<12 hours after symptom onset) at 2 centers. CMR and echocardiography were performed within 1 week after infarction using a standardized protocol. According to the results of CMR and echocardiography, patients were divided into PapMI with MR, PapMI (PapMI without MR), and non-PapMI groups. The primary clinical endpoint of the study was the occurrence of major adverse cardiovascular events (MACE).

Results: PapMI with MR was found in 27 patients (13%). The existence of PapMI with MR was associated with age (P<0.001), impaired left ventricular ejection fraction (LVEF) (P=0.005), higher SYNTAX score (P=0.002), concentration of troponin I (P<0.001), longer time to reperfusion (P<0.001), more diabetics (P<0.001), and microvascular occlusion (MVO) (P<0.001). Binary logistic regression with stepwise backward selection analysis showed that advanced age, MVO, and impaired LVEF were independent risk factors for PapMI with MR. Patients in the PapMI with MR group had significantly more MACE compared with the PapMI and non-PapMI groups [PapMI with MR, 23 (85.2%) PapMI, 21 (55.3%) non-PapMI, 29 (20.1%)] at 1-year follow-up (P<0.001). However, there were no pronounced differences in mortality rates among the 3 groups (P=0.071).

Conclusions: The presence of PapMI with MR in patients with STEMI is associated with advanced age, MVO, and impaired LVEF, which can increase the rates of MACE.

Citing Articles

Papillary Muscle Infarction by Cardiac MRI in Patients With Mitral Regurgitation.

Hou J, Sun Y, Wang H, Zhang L, Yang B Clin Cardiol. 2024; 47(7):e24312.

PMID: 38953314 PMC: 11217804. DOI: 10.1002/clc.24312.

Papillary Muscle Involvement during Acute Myocardial Infarction: Detection by Cardiovascular Magnetic Resonance Using T1 Mapping Technique and Papillary Longitudinal Strain.

Pambianchi G, Giannetti M, Marchitelli L, Cundari G, Maestrini V, Mancone M J Clin Med. 2023; 12(4).

PMID: 36836032 PMC: 9963367. DOI: 10.3390/jcm12041497.

Dark papillary muscles sign: a novel prognostic marker for cardiac magnetic resonance.

Aquaro G, De Gori C, Grilli G, Licordari R, Barison A, Todiere G Eur Radiol. 2023; 33(7):4621-4636.

PMID: 36692598 PMC: 10289986. DOI: 10.1007/s00330-023-09400-x.

Mitral regurgitation quantified by CMR 4D-flow is associated with microvascular obstruction post reperfused ST-segment elevation myocardial infarction.

Assadi H, Grafton-Clarke C, Demirkiran A, van der Geest R, Nijveldt R, Flather M BMC Res Notes. 2022; 15(1):181.

PMID: 35570318 PMC: 9107700. DOI: 10.1186/s13104-022-06063-7.

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