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Published on: September 17, 2015
Dark papillary muscles sign is a new prognostic indicator in patients with dilated cardiomyopathy: A multi-center
Rongxue Shan1, Yan Gao2, Wenxian Wang3
1School of Medicine, Shandong First Medical University, Jinan, Shandong 271099, China; Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China.
Insights
Left ventricular papillary muscle anomalies, identified as Dark-Paps via cardiac magnetic resonance, are a significant predictor of major adverse cardiac events in dilated cardiomyopathy patients. This finding offers improved prognostic insights beyond traditional clinical models.
Area of Science:
- Cardiology
- Cardiovascular Imaging
- Biomarkers
Background:
- Dilated cardiomyopathy (DCM) is a significant cause of heart failure.
- The prognostic value of left ventricular (LV) papillary muscle anomalies in DCM remains unclear.
- Cardiac magnetic resonance (CMR) allows detailed assessment of cardiac structures.
Purpose of the Study:
- To evaluate the prognostic significance of LV papillary muscle anomalies in DCM patients.
- To investigate the association between papillary muscle features and major adverse cardiac events (MACE).
- To determine if CMR-derived papillary muscle features improve risk stratification in DCM.
Main Methods:
- Retrospective analysis of 369 DCM patients who underwent CMR.
- Assessment of LV papillary muscle features including thickness, attachment, signal intensity.
- Identification of end-systolic signal hypointensity as 'Dark-Paps'.
- Follow-up for MACE and survival analysis using Kaplan-Meier and multivariate models.
Main Results:
- 119 patients (32.2%) presented with Dark-Paps.
- 141 patients (38.2%) experienced MACE during a median follow-up of 22 months.
- Dark-Paps was associated with significantly lower MACE-free survival (p < 0.001).
- Dark-Paps independently predicted MACE (HR: 3.49; p < 0.001) and improved prognostic model discrimination (C-statistic improvement from 0.652 to 0.777).
Conclusions:
- Dark-Paps identified via CMR is a potent independent predictor of MACE in DCM.
- Dark-Paps provides significant additional prognostic value beyond established clinical factors.
- This finding enhances risk stratification for DCM patients.
Objectives:
The prognostic value of left ventricular (LV) papillary muscle anomalies in dilated cardiomyopathy (DCM) patients is unclear. The objective of this study was to evaluate the prognostic significance of LV papillary muscle anomalies in DCM patients using cardiac magnetic resonance (CMR).
Methods:
369 DCM patients who underwent CMR at two Chinese medical facilities from January 2019 to June 2023 were retrospectively and consecutively included in total. The various features of the LV papillary muscles were taken into consideration: thickness, attachment, supernumerary papillary muscles, angles, and signal intensity. The end-systolic signal hypointensity of both papillary muscles in early post-contrast cine CMR images was identified as Dark-Paps. Major adverse cardiac events (MACEs) were assessed, and all patients were followed up.
Results:
119 patients (32.2 %) had Dark-Paps and 141 patients (38.2 %) experienced MACE during a median follow-up of 22 months. According to Kaplan-Meier curve analysis, patients who had Dark-Paps had a lower survival rate free from MACE (log-rank, p < 0.001). Dark-Paps maintained an independent predictor of MACE in a multivariate model that included left ventricular ejection fraction (LVEF) and late gadolinium enhancement (LGE) extent (HR: 3.49; p < 0.001). Furthermore, adding Dark-Paps to the multivariate model greatly enhanced the prognostic role of endpoint events (C-statistic improvement: 0.652-0.777, Delong test: p < 0.001).
Conclusion:
Dark-Paps is a potent independent indicator of major adverse cardiac events in dilated cardiomyopathy patients. In addition, Dark-Paps can provide additional prognostic value over the multivariable baseline clinical model.
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