TY - JOUR
T1 - 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
AU - Bouma, Wobbe
AU - Willemsen, Hendrik M.
AU - Lexis, Chris P. H.
AU - Prakken, Niek H.
AU - Lipsic, Erik
AU - van Veldhuisen, Dirk J.
AU - Mariani, Massimo A.
AU - van der Harst, Pim
AU - van der Horst, Iwan C. C.
PY - 2016/12
Y1 - 2016/12
N2 - 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.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.Between 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 (aeyengrade 2+).PMI 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.The 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.
AB - 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.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.Between 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 (aeyengrade 2+).PMI 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.The 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.
KW - Myocardial infarction
KW - Papillary muscle infarction
KW - Mitral regurgitation
KW - Echocardiography
KW - Magnetic resonance imaging
KW - LEFT-VENTRICULAR FUNCTION
KW - GLYCOMETABOLIC INTERVENTION
KW - CLINICAL-SIGNIFICANCE
KW - HEART-FAILURE
KW - DYSFUNCTION
KW - TRIAL
KW - REPERFUSION
KW - METFORMIN
KW - SEVERITY
KW - DISEASE
U2 - 10.1007/s00392-016-1006-9
DO - 10.1007/s00392-016-1006-9
M3 - Article
C2 - 27278636
SN - 1861-0684
VL - 105
SP - 981
EP - 991
JO - Clinical Research in Cardiology
JF - Clinical Research in Cardiology
IS - 12
ER -