Clinical significance of papillary muscle late enhancement detected via cardiac magnetic resonance imaging in patients with single old myocardial infarction

Okayama, Satoshi; Uemura, Shiro; Soeda, Tunenari; Onoue, Kenji; Somekawa, Satoshi; Ishigami, Kousei; Watanabe, Makoto; Nakajima, Tamio; Fujimoto, Shinichi; Saito, Yoshihiko

doi:10.1016/j.ijcard.2010.04.037

Cited by 24 publications

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References 36 publications

(43 reference statements)

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“…Several single-center studies have used contrast-enhanced magnetic resonance imaging (MRI) to detect infarction of the PMs. [9][10][11][12][13][14][15] In this issue of Circulation: Cardiovascular Imaging, Eitel et al 15 report findings derived from a multicenter study, the AIDA STEMI trial (the Abciximab Intracoronary versus intravenously Drug Application in STEMI), 16 in which contrast-enhanced MRI was performed <10 days after acute infarction. Contrast-enhanced MRI is the technique of choice for detecting scar tissue and fibrosis formation after myocardial infarction, and particularly the high resolution of this technique permits careful delineation of partial or complete involvement of the PMs in the infarcted area.…”

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confidence: 99%

“…On MRI, these patients had larger infarct size, scar more often observed in lateral and inferior walls, less myocardial salvage, increased microvascular obstruction, more intramyocardial hemorrhage, and larger LV volumes with impaired LV function. 15 Finally, the various studies that used contrast-enhanced MRI to detect PM infarction have also (to some extent) evaluated the relation with MR. Okayama et al 12 evaluated 60 patients with contrast-enhanced MRI at 25±47 months after infarction; 53% of patients had 1 or both PMs involved. From the same MRI examination, the mitral valve (presence of regurgitation, systolic retraction of the leaflets, annular size) and the left ventricle (function and sphericity) were evaluated.…”

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confidence: 99%

“…From the studies on contrast-enhanced MRI, it became clear that PM infarction is not directly related to MR. 11,12,14,15 Indeed, animal studies have already demonstrated that isolated PM infarction is not associated with significant MR. 5,6 Conversely, patients with PM infarction have larger infarctions, often with lateral wall involvement. However, PM infarction is related to LV remodeling, increased mitral annular dilatation, systolic retraction of the mitral leaflets, and reduced coaptation.…”

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Papillary Muscle Infarction, Mitral Regurgitation, and Long-Term Prognosis

Bax

Delgado

2013

Circ: Cardiovascular Imaging

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than the anterolateral PM (69% versus 31%). The increased vulnerability of the posteromedial PM is likely related to its blood supply, which is usually dependent on 1 artery (either the right coronary artery [RCA] or the left circumflex coronary artery [LCX]), whereas the anterolateral PM is supplied by 2 arteries (the left anterior descending coronary artery [LAD] and the LCX). 18 This was further supported by Chinitz et al 14 who demonstrated that in patients with posteromedial PM infarction the LCX was the infarct-related artery in 33% and the RCA in 67%, whereas the LAD was never involved. Conversely, in patients with anterolateral PM infarction, the LAD was the infarct-related artery in 72% of patients, the LCX in 22%, and the RCA in 6%. 14 Third, there seems to be some variability in the clinical correlates associated with PM infarction. Chinitz et al 14 demonstrated that patients with PM infarction had larger infarct size on MRI (16.0±10.9% of the LV versus 12.3±8.9% in patients without PM involvement; P<0.05). In these patients, myocardial scar most often involved the lateral and inferior walls. In addition, the infarct-related artery was more often the RCA or LCX. Similar findings were reported in the current study by Eitel et al 15 ; patients with PM infarction had delayed reperfusion, more often multivessel disease, and a lower frequency of LAD as infarct-related artery and anterior infarction. On MRI, these patients had larger infarct size, scar more often observed in lateral and inferior walls, less myocardial salvage, increased microvascular obstruction, more intramyocardial hemorrhage, and larger LV volumes with impaired LV function. 15 Finally, the various studies that used contrast-enhanced MRI to detect PM infarction have also (to some extent) evaluated the relation with MR. Okayama et al 12 evaluated 60 patients with contrast-enhanced MRI at 25±47 months after infarction; 53% of patients had 1 or both PMs involved. From the same MRI examination, the mitral valve (presence of regurgitation, systolic retraction of the leaflets, annular size) and the left ventricle (function and sphericity) were evaluated. Patients with involvement of both PMs demonstrated larger LV volumes, lower LV ejection fraction, and worse LV sphericity index. These patients had more severe MR associated with mitral annular dilatation, reduced leaflet coaptation, and systolic retraction of the leaflets (expressed as a larger mitral valve tenting area).12 Chinitz et al 14 performed the MRI <27±8 days after infarction and used echocardiography to assess the severity of MR. Among the total study population, moderate to severe MR was present in 14%; these patients had worse LV function, LV dilatation, mitral annular dilatation, increased tenting height, and reduced leaflet coaptation.14 On contrastenhanced MRI, the patients with MR had more frequent lateral wall infarction (which remained an independent predictor on the multivariable analysis). However, PM infarction was not associated with MR in multivariable analysis. Eitel...

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Section: Article See P 890mentioning

confidence: 99%

Section: Article See P 890mentioning

confidence: 99%

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Papillary Muscle Infarction, Mitral Regurgitation, and Long-Term Prognosis

Bax

Delgado

2013

Circ: Cardiovascular Imaging

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“…Beyond functional imaging and direct MR assessment, CMR enables identification of tissue properties that can contribute to ischemic MR. CMR can identify infarction within the papillary muscles as well as underlying LV myocardium (Figure 4), and has been used to study differential impact of MI in each region on MR: in some studies, papillary muscle infarction (PMI) has been associated with MR (22), whereas other studies have largely found no such association (21,54,55). Our group investigated the relative impact of PMI on MR, finding that PMI was closely linked to MI in the underlying LV chamber wall, which was the primary determinant of MR severity (21).…”

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confidence: 99%

“…More broadly, cine-CMR can quantify changes in LV function and size with high precision so as to guide decision-making for mitral valve interventions. Delayed enhancement CMR (DE-CMR) enables highly accurate assessment of myocardial infarction (MI) within LV myocardium underlying the mitral valve-a known causal substrate for MR (21,22). This article will review established literature concerning utility of CMR for evaluation of MR severity and causality, as well as emerging data concerning utility of CMR for predicting MR response to therapeutic interventions.…”

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Utility of cardiac magnetic resonance for evaluation of mitral regurgitation prior to mitral valve surgery

et al. 2017

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Mitral regurgitation (MR) is a common cause of morbidity worldwide and an accepted indication for interventional therapies which aim to reduce or resolve adverse clinical outcomes associated with MR.Cardiac magnetic resonance (CMR) provides highly accurate means of assessing MR, including a variety of approaches that can measure MR based on quantitative flow. Additionally, CMR is widely accepted as a reference standard for cardiac chamber quantification, enabling reliable detection of subtle changes in cardiac chamber size and function so as to guide decision-making regarding timing of mitral valve directed therapies. Beyond geometric imaging, CMR enables tissue characterization of ischemia and infarction in the left ventricular (LV) myocardium as well as within the mitral valve apparatus, thus enabling identification of structural substrates for MR. This review provides an overview of established and emerging CMR approaches to measure valvular regurgitation, including relative utility of different approaches for patients with primary or secondary MR. Clinical outcomes studies are discussed with focus on data demonstrating advantages of CMR for guiding diagnosis, risk stratification, and management of patients with known or suspected MR. Comparative data is reviewed with focus on diagnostic performance of CMR in comparison to conventional assessment via echocardiography (echo). Emerging literature is reviewed concerning potential new approaches that utilize CMR tissue characterization to guide clinical decision-making in order to improve therapeutic outcomes and clinical prognosis for patients with MR. J Thorac Dis 2017;9(Suppl 4):S246-S256 jtd.amegroups.com pre-operative morbidity and decreases procedural efficacy (9,10), possibly due to impact of LV or left atrial (LA) dilation on mitral apparatus geometry or wall stress (11-13). Accordingly, consensus guidelines recommend surgery for patients with severe primary MR if symptoms are present or, in the case of asymptomatic individuals, if LV dysfunction (ejection fraction <60%) or chamber dilation (end-systolic diameter ≥40 mm) is present (14). Echocardiography (echo) is widely used to guide decision-making concerning timing of interventional therapies for MR (14). However, echo can be suboptimal for this purpose, as image quality can vary (15), chamber quantification is typically predicated on 2-dimensional (2D) geometric assumptions [rather than 3-dimensional (3D) imaging] (16), and MR quantification can be challenging in the context of regurgitant jet eccentricity (17). These limitations may explain recent data suggesting lack of correlation between pre-operative echo-quantified MR severity and LV reverse remodeling after mitral valve surgery (18). Knowledge gaps regarding predictors of procedural success limit the ability to optimize decision-making for patients with MR.Cardiac magnetic resonance (CMR) can assess MR as well as its predisposing risk factors. A variety of CMR pulse sequences can be used for MR assessment ( Table 1). Phase velocity en...

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Cardiovascular magnetic resonance imaging in ischemic heart disease

Knobelsdorff‐Brenkenhoff

Schulz‐Menger

2012

Magnetic Resonance Imaging

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Ischemic heart disease is the most frequent etiology for cardiovascular morbidity and mortality. Early detection and accurate monitoring are essential to guide optimal patient treatment and assess the individual's prognosis. In this regard, cardiovascular magnetic resonance (CMR), which entered the arena of noninvasive cardiovascular imaging over the past two decades, became a very important imaging modality, mainly due to its unique versatility. CMR has proven accuracy and is a robust technique for the assessment of myocardial function both at rest and during stress. It also allows stress perfusion analysis with high spatial and temporal resolution, and provides a means by which to differentiate tissue such as distinguishing between reversibly and irreversibly injured myocardium. In particular, the latter aspect is a unique benefit of CMR compared with other noninvasive imaging modalities such as echocardiography and nuclear medicine, and provides novel information concerning the presence, size, transmurality, and prognosis of myocardial infarction. This article is intended to provide the reader with an overview of the various applications of CMR for the assessment of ischemic heart disease from a clinical perspective. J. Magn. Reson. Imaging 2012;36:20–38. © 2012 Wiley Periodicals, Inc.

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Clinical significance of papillary muscle late enhancement detected via cardiac magnetic resonance imaging in patients with single old myocardial infarction

Cited by 24 publications

References 36 publications

Papillary Muscle Infarction, Mitral Regurgitation, and Long-Term Prognosis

Papillary Muscle Infarction, Mitral Regurgitation, and Long-Term Prognosis

Utility of cardiac magnetic resonance for evaluation of mitral regurgitation prior to mitral valve surgery

Cardiovascular magnetic resonance imaging in ischemic heart disease

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