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Rofo 2018; 190(01): 42-50
DOI: 10.1055/s-0043-115121
Heart
© Georg Thieme Verlag KG Stuttgart · New York

Impact of Papillary Muscle Infarction on Ischemic Mitral Regurgitation Assessed by Magnetic Resonance Imaging

Einfluss eines Papillarmuskelinfarktes auf die Entstehung einer ischämischen Mitralklappeninsuffizienz in der MRT
Christiane Bretschneider
1   Radiology, Klinikum Frankfurt Hochst GmbH, Frankfurt am Main, Germany
,
Hannah-Klara Heinrich
2   Diagnostic and interventional Radiology, Universitätsklinikum Tübingen, Tuebingen, Germany
,
Achim Seeger
3   Radiologiepraxis Tuebingen, Radiologiepraxis Tuebingen, Germany
,
Christof Burgstahler
4   Sports Medicine, Universitätsklinikum Tübingen, Tuebingen, Germany
,
Stephan Miller
3   Radiologiepraxis Tuebingen, Radiologiepraxis Tuebingen, Germany
,
Ulrich Kramer
2   Diagnostic and interventional Radiology, Universitätsklinikum Tübingen, Tuebingen, Germany
,
Meinrad Gawaz
5   Cardiology, Universitätsklinikum Tübingen, Tuebingen, Germany
,
Konstantin Nikolaou
2   Diagnostic and interventional Radiology, Universitätsklinikum Tübingen, Tuebingen, Germany
,
Bernhard Klumpp
2   Diagnostic and interventional Radiology, Universitätsklinikum Tübingen, Tuebingen, Germany
› Author Affiliations
Further Information

Publication History

20 March 2017

06 June 2017

Publication Date:
03 November 2017 (online)

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Abstract

Objective Ischemic mitral regurgitation is a predictor of heart failure resulting in increased mortality in patients with chronic myocardial infarction. It is uncertain whether the presence of papillary muscle (PM) infarction contributes to the development of mitral regurgitation in patients with chronic myocardial infarction (MI). The aim of the present study was to assess the correlation of PM infarction depicted by MRI with mitral regurgitation and left ventricular function.

Methods and Materials 48 patients with chronic MI and recent MRI and echocardiography were retrospectively included. The location and extent of MI depicted by MRI were correlated with left ventricular function assessed by MRI and mitral regurgitation assessed by echocardiography. The presence, location and extent of PM infarction depicted by late gadolinium enhancement (LGE-) MRI were correlated with functional parameters and compared with patients with chronic MI but no PM involvement.

Results PM infarction was found in 11 of 48 patients (23 %) using LGE-MRI. 8/11 patients (73 %) with PM infarction and 22/37 patients (59 %) without PM involvement in MI had ischemic mitral regurgitation. There was no significant difference between location, extent of MI and presence of mitral regurgitation between patients with and without PM involvement in myocardial infarction. In 4/4 patients with complete and in 4/7 patients with partial PM infarction, mitral regurgitation was present. The normalized mean left ventricular end-diastolic volume was increased in patients with ischemic mitral regurgitation.

Conclusion The presence of PM infarction does not correlate with ischemic mitral regurgitation. In patients with complete PM infarction and consequent discontinuity of viable tissue in the PM-chorda-mitral valve complex, the probability of developing ischemic mitral regurgitation seems to be increased. However, the severity of mitral regurgitation is not increased compared to patients with partial or no PM infarction.

Key points 

  • No correlation between ischemic mitral regurgitation and presence of papillary muscle infarction

  • Complete papillary muscle infarction results in dysfunction associated with ischemic mitral regurgitation

  • Severity of mitral regurgitation not increased in patients with complete PM infarction

Citation Format

  • Bretschneider C, Heinrich H, Seeger A et al. Impact of Papillary Muscle Infarction on Ischemic Mitral Regurgitation Assessed by Magnetic Resonance Imaging. Fortschr Röntgenstr 2018; 190: 42 – 50

Zusammenfassung

Zielsetzung Die ischämische Mitralinsuffizienz ist ein negativer Prädiktor für eine Herzinsuffizienz und für eine hierdurch bedingte erhöhte Mortalität von Patienten mit chronischem Myokardinfarkt (MI). Ein kausaler Zusammenhang zwischen Papillarmuskelinfarkt (PMI) und ischämisch bedingter Mitralinsuffizienz ist unsicher. Ziel der vorgestellten Studie war es, den Zusammenhang von PMI in der MRT und Mitralinsuffizienz sowie linksventrikulärer Funktion zu untersuchen.

Material und Methodik 48 Patienten mit chronischem MI und aktuellem MRT und Echokardiografie wurden retrospektiv eingeschlossen. Lokalisation und Ausmaß des MI in der MRT wurden mit der linksventrikulären Funktion in der MRT und der Mitralinsuffizienz in der Echokardiografie korreliert. Vorhandensein, Lokalisation und Ausmaß eines PMI in der Late-Gadolinium Enhancement (LGE-) MRT wurden mit diesen Funktionsparametern korreliert und mit Patienten mit chronischem MI ohne PMI verglichen.

Ergebnisse Bei 11 von 48 Patienten (23 %) konnte mittels LGE-MRT ein PMI nachgewiesen werden. Eine ischämische Mitralinsuffizienz bestand bei 8/11 Patienten mit PMI (73 %) und bei 22/37 Patienten mit MI ohne PMI (59 %). Es ergab sich kein signifikanter Unterschied hinsichtlich Lokalisation und Ausmaß des MI und der Mitralinsuffizienz zwischen Patienten mit und ohne PMI. Bei 4/4 Patienten mit vollständigem und bei 4/7 Patienten mit partiellem PMI bestand eine Mitralinsuffizienz. Das mittlere enddiastolische Volumen war bei Patienten mit Mitralinsuffizienz erhöht.

Schlussfolgerung Es ergibt sich kein eindeutiger Zusammenhang zwischen dem Vorhandensein eines PMI und der Entwicklung einer ischämischen Mitralinsuffizienz. Bei Patienten mit vollständigem PMI scheint aufgrund einer Unterbrechung der Kontinuität vitalen Gewebes des Papillarmuskel-Chorda-Mitralklappen Komplex ein erhöhtes Risiko für das Auftreten einer ischämischen Mitralinsuffizienz zu bestehen. Der Schweregrad der Mitralinsuffizienz ist im Vergleich zu Patienten mit partiellem oder ohne PMI nicht erhöht.

Kernaussagen 

  • Kein Zusammenhang zwischen Vorhandensein eines Papillarmuskelinfarkts und ischämischer Mitralinsuffizienz

  • Vollständiger Papillarmuskelinfarkt führt zu Funktionsstörung und ist mit ischämischer Mitralinsuffizienz assoziiert

  • Schweregrad der Mitralinsuffizienz bei vollständigem Papillarmuskelinfarkt nicht höher

Key words

LGE MRI - ischemic mitral regurgitation - myocardial infarction - papillary muscle
 

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