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Abstract：
BACKGROUND: Papillary muscle (PM) infarction (PMI) detected by cardiac magnetic resonance imaging (CMR) is associated with poor outcomes. Whether PM parameters provide more value for mitral regurgitation (MR) management currently remains unclear. Therefore, we examined the prognostic value of PMI using CMR in patients with MR.
METHODS: Between March 2018 and July 2023, we retrospectively enrolled 397 patients with MR undergoing CMR. CMR was used to detect PMI qualitatively and quantitively. We also collected baseline clinical, echocardiography, and follow-up data.
RESULTS: Of the 397 patients with MR (52.4 ± 13.9 years), 117 (29.5%) were assigned to the PMI group, with 280 (70.5%) in the non-PMI group. PMI was demonstrated more in the posteromedial PM (PM-PM, 98/117) than in the anterolateral PM (AL-PM, 45/117). Compared with patients without PMI, patients with PMI had a decreased AL-PM (41.5 ± 5.4 vs. 45.6 ± 5.3)/PM-PM diastolic length (35.0 ± 5.2 vs. 37.9 ± 4.0), PM-longitudinal strain (LS, 20.4 ± 6.1 vs. 24.9 ± 4.6), AL-PM-LS (19.7 ± 6.8 vs. 24.7 ± 5.6)/PM-PM-LS (21.2 ± 7.9 vs. 25.2 ± 6.0), and increased inter-PM distance (25.7 ± 8.0 vs. 22.7 ± 6.2, all p < 0.001). Multiple logistic regression analyses identified male sex (odds ratio [OR] = 3.65, 95% confidence interval = 1.881-7.081, p < 0.001) diabetes mellitus (OR/95% CI/p = 2.534/1.13-5.68/0.024), AL-PM diastolic length (OR/95% CI/p = 0.841/0.77-0.92/< 0.001), PM-PM diastolic length (OR/95% CI/p = 0.873/0.79-0.964/0.007), inter-PM distance (OR/95% CI/p = 1.087/1.028-1.15/0.003), AL-PM-LS (OR/95% CI/p = 0.892/0.843-0.94/< 0.001), and PM-PM-LS (OR/95% CI/p = 0.95/0.9-0.992/0.021) as independently associated with PMI. Over a 769 ± 367-day follow-up, 100 (25.2%) patients had arrhythmia. Cox regression analyses indicated that PMI (hazard ratio [HR]/95% CI/p = 1.644/1.062-2.547/0.026), AL-PM-LS (HR/95% CI/p = 0.937/0.903-0.973/0.001), and PM-PM-LS (HR/95% CI/p = 0.933/0.902-0.965/< 0.001) remained independently associated with MR.
CONCLUSIONS: The CMR-derived PMI and LS parameters improve the evaluation of PM dysfunction, indicating a high risk for arrhythmia, and provide additive risk stratification for patients with MR.
METHODS: Between March 2018 and July 2023, we retrospectively enrolled 397 patients with MR undergoing CMR. CMR was used to detect PMI qualitatively and quantitively. We also collected baseline clinical, echocardiography, and follow-up data.
RESULTS: Of the 397 patients with MR (52.4 ± 13.9 years), 117 (29.5%) were assigned to the PMI group, with 280 (70.5%) in the non-PMI group. PMI was demonstrated more in the posteromedial PM (PM-PM, 98/117) than in the anterolateral PM (AL-PM, 45/117). Compared with patients without PMI, patients with PMI had a decreased AL-PM (41.5 ± 5.4 vs. 45.6 ± 5.3)/PM-PM diastolic length (35.0 ± 5.2 vs. 37.9 ± 4.0), PM-longitudinal strain (LS, 20.4 ± 6.1 vs. 24.9 ± 4.6), AL-PM-LS (19.7 ± 6.8 vs. 24.7 ± 5.6)/PM-PM-LS (21.2 ± 7.9 vs. 25.2 ± 6.0), and increased inter-PM distance (25.7 ± 8.0 vs. 22.7 ± 6.2, all p < 0.001). Multiple logistic regression analyses identified male sex (odds ratio [OR] = 3.65, 95% confidence interval = 1.881-7.081, p < 0.001) diabetes mellitus (OR/95% CI/p = 2.534/1.13-5.68/0.024), AL-PM diastolic length (OR/95% CI/p = 0.841/0.77-0.92/< 0.001), PM-PM diastolic length (OR/95% CI/p = 0.873/0.79-0.964/0.007), inter-PM distance (OR/95% CI/p = 1.087/1.028-1.15/0.003), AL-PM-LS (OR/95% CI/p = 0.892/0.843-0.94/< 0.001), and PM-PM-LS (OR/95% CI/p = 0.95/0.9-0.992/0.021) as independently associated with PMI. Over a 769 ± 367-day follow-up, 100 (25.2%) patients had arrhythmia. Cox regression analyses indicated that PMI (hazard ratio [HR]/95% CI/p = 1.644/1.062-2.547/0.026), AL-PM-LS (HR/95% CI/p = 0.937/0.903-0.973/0.001), and PM-PM-LS (HR/95% CI/p = 0.933/0.902-0.965/< 0.001) remained independently associated with MR.
CONCLUSIONS: The CMR-derived PMI and LS parameters improve the evaluation of PM dysfunction, indicating a high risk for arrhythmia, and provide additive risk stratification for patients with MR.
摘要：
背景：心脏磁共振成像（CMR）检测到的乳头状肌（PM）梗死（PMI）与不良预后相关。目前尚不清楚PM参数是否为二尖瓣返流（MR）管理提供了更多价值。因此,我们在MR患者中使用CMR检查了PMI的预后价值。
方法：在2018年3月至2023年7月之间，我们回顾性招募了397例接受CMR的MR患者。CMR用于定性和定量检测PMI。我们还收集了基线临床，超声心动图,和后续数据。
结果：在397例MR患者（52.4±13.9岁）中，117（29.5%）被分配到PMI组，非PMI组中有280人（70.5%）。PMI在后内侧PM(PM-PM，98/117）比在前外侧PM（AL-PM，45/117)。与无PMI患者相比,PMI患者AL-PM降低（41.5±5.4vs.45.6±5.3)/PM-PM舒张长度(35.0±5.2vs.37.9±4.0),PM-纵向应变(LS,20.4±6.1vs.24.9±4.6),AL-PM-LS（19.7±6.8vs.24.7±5.6)/PM-PM-LS(21.2±7.9vs.25.2±6.0)，并增加PM间距(25.7±8.0vs.22.7±6.2，所有p<0.001）。多元逻辑回归分析确定男性（优势比[OR]=3.65，95％置信区间=1.881-7.081，p<0.001）糖尿病（OR/95％CI/p=2.534/1.13-5.68/0.024），AL-PM舒张长度（OR/95%CI/p=0.841/0.77-0.92/<0.001），PM-PM舒张长度（OR/95%CI/p=0.873/0.79-0.964/0.007），PM间距（OR/95%CI/p=1.087/1.028-1.15/0.003），AL-PM-LS（OR/95%CI/p=0.892/0.843-0.94/<0.001），PM-PM-LS(OR/95%CI/p=0.95/0.9-0.992/0.021)与PMI独立相关。在769±367天的随访中，100例（25.2%）患者出现心律失常。Cox回归分析表明，PMI(风险比[HR]/95%CI/p=1.544/1.062-2.547/0.026)，AL-PM-LS（HR/95%CI/p=0.937/0.903-0.973/0.001），PM-PM-LS(HR/95%CI/p=0.933/0.902-0.965/<0.001)与MR保持独立相关。
结论：CMR衍生的PMI和LS参数改善了PM功能障碍的评估，表明心律失常的风险很高，并为MR患者提供附加风险分层。
方法：在2018年3月至2023年7月之间，我们回顾性招募了397例接受CMR的MR患者。CMR用于定性和定量检测PMI。我们还收集了基线临床，超声心动图,和后续数据。
结果：在397例MR患者（52.4±13.9岁）中，117（29.5%）被分配到PMI组，非PMI组中有280人（70.5%）。PMI在后内侧PM(PM-PM，98/117）比在前外侧PM（AL-PM，45/117)。与无PMI患者相比,PMI患者AL-PM降低（41.5±5.4vs.45.6±5.3)/PM-PM舒张长度(35.0±5.2vs.37.9±4.0),PM-纵向应变(LS,20.4±6.1vs.24.9±4.6),AL-PM-LS（19.7±6.8vs.24.7±5.6)/PM-PM-LS(21.2±7.9vs.25.2±6.0)，并增加PM间距(25.7±8.0vs.22.7±6.2，所有p<0.001）。多元逻辑回归分析确定男性（优势比[OR]=3.65，95％置信区间=1.881-7.081，p<0.001）糖尿病（OR/95％CI/p=2.534/1.13-5.68/0.024），AL-PM舒张长度（OR/95%CI/p=0.841/0.77-0.92/<0.001），PM-PM舒张长度（OR/95%CI/p=0.873/0.79-0.964/0.007），PM间距（OR/95%CI/p=1.087/1.028-1.15/0.003），AL-PM-LS（OR/95%CI/p=0.892/0.843-0.94/<0.001），PM-PM-LS(OR/95%CI/p=0.95/0.9-0.992/0.021)与PMI独立相关。在769±367天的随访中，100例（25.2%）患者出现心律失常。Cox回归分析表明，PMI(风险比[HR]/95%CI/p=1.544/1.062-2.547/0.026)，AL-PM-LS（HR/95%CI/p=0.937/0.903-0.973/0.001），PM-PM-LS(HR/95%CI/p=0.933/0.902-0.965/<0.001)与MR保持独立相关。
结论：CMR衍生的PMI和LS参数改善了PM功能障碍的评估，表明心律失常的风险很高，并为MR患者提供附加风险分层。
