Chronic ischemic mitral regurgitation and papillary muscle infarction detected by late gadolinium-enhanced cardiac magnetic resonance imaging in patients with ST-segment elevation myocardial infarction.

Wobbe Bouma,Pim Van Der Harst,Erik Lipsic,Dirk J Van Veldhuisen,Hendrik M Willemsen,Massimo A Mariani,Niek H Prakken,Iwan C C Van Der Horst,Chris P H Lexis

doi:10.1007/s00392-016-1006-9

Abstract

BackgroundBoth papillary muscle infarction (PMI) and chronic ischemic mitral regurgitation (CIMR) are associated with reduced survival after myocardial infarction. The influence of PMI on CIMR and factors influencing both entities are incompletely understood.ObjectivesWe sought to determine the influence of PMI on CIMR after primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) and to define independent predictors of PMI and CIMR.MethodsBetween January 2011 and May 2013, 263 patients (mean age 57.8 ± 11.5 years) underwent late gadolinium-enhanced cardiac magnetic resonance imaging and transthoracic echocardiography 4 months after PCI for STEMI. Infarct size, PMI, and mitral valve and left ventricular geometric and functional parameters were assessed. Univariate and multivariate analyses were performed to identify predictors of PMI and CIMR (≥grade 2+).ResultsPMI was present in 61 patients (23 %) and CIMR was present in 86 patients (33 %). In patients with PMI, 52 % had CIMR, and in patients without PMI, 27 % had CIMR (P < 0.001). In multivariate analyses, infarct size [odds ratio (OR) 1.09 (95 % confidence interval 1.04–1.13), P < 0.001], inferior MI [OR 4.64 (1.04–20.62), P = 0.044], and circumflex infarct-related artery [OR 8.21 (3.80–17.74), P < 0.001] were independent predictors of PMI. Age [OR 1.08 (1.04–1.11), P < 0.001], infarct size [OR 1.09 (1.03-1.16), P = 0.003], tethering height [OR 19.30 (3.28–113.61), P = 0.001], and interpapillary muscle distance [OR 3.32 (1.31–8.42), P = 0.011] were independent predictors of CIMR.ConclusionsThe risk of PMI is mainly associated with inferior infarction and infarction in the circumflex coronary artery. Although the prevalence of CIMR is almost doubled in the presence of PMI, PMI is not an independent predictor of CIMR. Tethering height and interpapillary muscle distance are the strongest independent predictors of CIMR.

Highlights

Both papillary muscle infarction (PMI) and chronic ischemic mitral regurgitation (CIMR) are associated with reduced survival after myocardial infarction (MI) [1,2,3].Ischemic mitral regurgitation (IMR) is a common complication of MI with an estimated incidence of 20–50 % [4,5,6,7,8]
We sought to determine the influence of PMI on CIMR after primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) and to define independent predictors of PMI and CIMR
PMI was present in 61 patients (23 %) and CIMR was present in 86 patients (33 %)

Summary

Introduction

Both papillary muscle infarction (PMI) and chronic ischemic mitral regurgitation (CIMR) are associated with reduced survival after myocardial infarction (MI) [1,2,3].Ischemic mitral regurgitation (IMR) is a common complication of MI with an estimated incidence of 20–50 % [4,5,6,7,8]. Both papillary muscle infarction (PMI) and chronic ischemic mitral regurgitation (CIMR) are associated with reduced survival after myocardial infarction (MI) [1,2,3]. IMR may develop acutely after post-MI papillary muscle rupture, or more gradually with scar formation, LV remodeling, papillary muscle (PM) displacement, and mitral valve tethering or tenting (i.e. CIMR) [9, 10]. Both papillary muscle infarction (PMI) and chronic ischemic mitral regurgitation (CIMR) are associated with reduced survival after myocardial infarction. The influence of PMI on CIMR and factors influencing both entities are incompletely understood

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