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.
BACKGROUND
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.


OBJECTIVE
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.


METHODS
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 (≥grade 2+).


RESULTS
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.


CONCLUSIONS
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.
Department of Cardiothoracic Surgery, University Medical Center Groningen, University of Groningen, P.O. Box 30001, 9700 RB, Groningen, The Netherlands. w.bouma@umcg.nl.
Wobbe
W
Bouma
Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Hendrik M
HM
Willemsen
Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Chris P H
CP
Lexis
Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Niek H
NH
Prakken
Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Erik
E
Lipsic
Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Dirk J
DJ
van Veldhuisen
Department of Cardiothoracic Surgery, University Medical Center Groningen, University of Groningen, P.O. Box 30001, 9700 RB, Groningen, The Netherlands.
Massimo A
MA
Mariani
Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Pim
P
van der Harst
Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Iwan C C
IC
van der Horst
D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D002908:Chronic Disease; D003287:Contrast Media; D004311:Double-Blind Method; D018618:Echocardiography, Doppler, Color; D005260:Female; D006801:Humans; D016015:Logistic Models; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008536:Meglumine; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000503:physiopathology; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D015999:Multivariate Analysis; D009426:Netherlands; D016017:Odds Ratio; D009942:Organometallic Compounds; D010210:Papillary Muscles / Q000473:pathology*; D062645:Percutaneous Coronary Intervention; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D000072657:ST Elevation Myocardial Infarction / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology / Q000628:therapy; D013997:Time Factors; D016896:Treatment Outcome
D003287:Contrast Media; D009942:Organometallic Compounds; D008536:Meglumine; C072417:gadoterate meglumine
Echocardiography; Magnetic resonance imaging; Mitral regurgitation; Myocardial infarction; Papillary muscle infarction