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Papillary Muscle Involvement during Acute Myocardial Infarction: Detection by Cardiovascular Magnetic Resonance Using
Giacomo Pambianchi1, Martina Giannetti1, Livia Marchitelli1
1Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, 00161 Rome, Italy.
Abstract:
Papillary muscle (PPM) involvement in myocardial infarction (MI) increases the risk of secondary mitral valve regurgitation or PPM rupture and may be diagnosed using late gadolinium enhancement (LGE) imaging. The native T1-mapping (nT1) technique and PPM longitudinal strain (PPM-ls) have been used to identify PPM infarction (iPPM) without the use of the contrast agent. This study aimed to assess the diagnostic performance of nT1 and PPM-ls in the identification of iPPM. Forty-six patients, who performed CMR within 14-30 days after MI, were retrospectively enrolled: sixteen showed signs of iPPM on LGE images. nT1 values were measured within the infarcted area (IA), remote myocardium (RM), blood pool (BP), and anterolateral and posteromedial PPMs and compared using ANOVA. PPM-ls values have been assessed on cineMR images as the percentage of shortening between end-diastolic and end-systolic phases. Higher nT1 values and lower PPM-ls were found in infarcted compared to non-infarcted PPMs (nT1: 1219.3 ± 102.5 ms vs. 1052.2 ± 80.5 ms and 17.6 ± 6.3% vs. 21.6 ± 4.3%; p-value < 0.001 for both), with no significant differences between the nT1 of infarcted PPMs and IA and between the non-infarcted PPMs and RM. ROC analysis demonstrated an excellent discriminatory power for nT1 in detecting the iPPM (AUC = 0.874; 95% CI: 0.784-0.963; p < 0.001). nT1 and PPM-ls are valid tools in assessing iPPM with the advantage of avoiding contrast media administration.
Insights
Native T1-mapping (nT1) and papillary muscle longitudinal strain (PPM-ls) can identify papillary muscle infarction (iPPM) after myocardial infarction (MI) without contrast agents. These techniques show excellent diagnostic performance, aiding in risk assessment for complications.
Area of Science:
- Cardiovascular Imaging
- Cardiac MRI
- Myocardial Infarction
Background:
- Papillary muscle (PPM) involvement in myocardial infarction (MI) increases risks of mitral valve regurgitation and rupture.
- Late gadolinium enhancement (LGE) is used for diagnosing PPM infarction (iPPM), but requires contrast agents.
- Native T1-mapping (nT1) and PPM longitudinal strain (PPM-ls) offer potential contrast-free methods for iPPM detection.
Purpose of the Study:
- To evaluate the diagnostic performance of nT1 and PPM-ls in identifying iPPM.
- To compare nT1 and PPM-ls values in infarcted versus non-infarcted papillary muscles.
- To assess the utility of these techniques in patients post-MI.
Main Methods:
- Retrospective analysis of 46 patients with MI, 16 showing iPPM on LGE imaging.
- Measurement of nT1 values in infarcted area, remote myocardium, blood pool, and PPMs.
- Assessment of PPM-ls from cine-MRI, measuring shortening between end-diastole and end-systole.
Main Results:
- Higher nT1 values and lower PPM-ls were observed in infarcted compared to non-infarcted PPMs (p < 0.001 for both).
- nT1 values in infarcted PPMs were similar to the infarcted area, and in non-infarcted PPMs to remote myocardium.
- Receiver Operating Characteristic (ROC) analysis showed excellent discriminatory power for nT1 in detecting iPPM (AUC = 0.874, p < 0.001).
Conclusions:
- Native T1-mapping and PPM longitudinal strain are effective tools for assessing papillary muscle infarction.
- These contrast-free MRI techniques offer a valuable alternative for iPPM diagnosis.
- This approach aids in evaluating patients at risk for MI-related complications.
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