Jie Hou, Yu Sun, Huishan Wang, Libo Zhang, Benqiang Yang
{"title":"二尖瓣反流患者心脏磁共振成像显示的乳头肌梗塞","authors":"Jie Hou, Yu Sun, Huishan Wang, Libo Zhang, Benqiang Yang","doi":"10.1002/clc.24312","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Background</h3>\n \n <p>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.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>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.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>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 <i>p</i> < 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/<i>p</i> = 2.534/1.13–5.68/0.024), AL-PM diastolic length (OR/95% CI/<i>p</i> = 0.841/0.77–0.92/< 0.001), PM-PM diastolic length (OR/95% CI/<i>p</i> = 0.873/0.79–0.964/0.007), inter-PM distance (OR/95% CI/<i>p</i> = 1.087/1.028–1.15/0.003), AL-PM-LS (OR/95% CI/<i>p</i> = 0.892/0.843–0.94/< 0.001), and PM-PM-LS (OR/95% CI/<i>p</i> = 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/<i>p</i> = 1.644/1.062–2.547/0.026), AL-PM-LS (HR/95% CI/<i>p</i> = 0.937/0.903–0.973/0.001), and PM-PM-LS (HR/95% CI/<i>p</i> = 0.933/0.902–0.965/< 0.001) remained independently associated with MR.</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>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.</p>\n </section>\n </div>","PeriodicalId":2,"journal":{"name":"ACS Applied Bio Materials","volume":null,"pages":null},"PeriodicalIF":4.6000,"publicationDate":"2024-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11217804/pdf/","citationCount":"0","resultStr":"{\"title\":\"Papillary Muscle Infarction by Cardiac MRI in Patients With Mitral Regurgitation\",\"authors\":\"Jie Hou, Yu Sun, Huishan Wang, Libo Zhang, Benqiang Yang\",\"doi\":\"10.1002/clc.24312\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Background</h3>\\n \\n <p>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.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Methods</h3>\\n \\n <p>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.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Results</h3>\\n \\n <p>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 <i>p</i> < 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/<i>p</i> = 2.534/1.13–5.68/0.024), AL-PM diastolic length (OR/95% CI/<i>p</i> = 0.841/0.77–0.92/< 0.001), PM-PM diastolic length (OR/95% CI/<i>p</i> = 0.873/0.79–0.964/0.007), inter-PM distance (OR/95% CI/<i>p</i> = 1.087/1.028–1.15/0.003), AL-PM-LS (OR/95% CI/<i>p</i> = 0.892/0.843–0.94/< 0.001), and PM-PM-LS (OR/95% CI/<i>p</i> = 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/<i>p</i> = 1.644/1.062–2.547/0.026), AL-PM-LS (HR/95% CI/<i>p</i> = 0.937/0.903–0.973/0.001), and PM-PM-LS (HR/95% CI/<i>p</i> = 0.933/0.902–0.965/< 0.001) remained independently associated with MR.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Conclusions</h3>\\n \\n <p>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.</p>\\n </section>\\n </div>\",\"PeriodicalId\":2,\"journal\":{\"name\":\"ACS Applied Bio Materials\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":4.6000,\"publicationDate\":\"2024-07-02\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11217804/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"ACS Applied Bio Materials\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://onlinelibrary.wiley.com/doi/10.1002/clc.24312\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"MATERIALS SCIENCE, BIOMATERIALS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"ACS Applied Bio Materials","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1002/clc.24312","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"MATERIALS SCIENCE, BIOMATERIALS","Score":null,"Total":0}
引用次数: 0
摘要
背景：心脏磁共振成像（CMR）检测到的乳头肌梗死（PMI）与不良预后有关。目前，乳头肌参数是否能为二尖瓣反流（MR）治疗提供更多价值仍不清楚。因此，我们利用CMR检查了二尖瓣反流患者PMI的预后价值：2018年3月至2023年7月期间，我们回顾性入组了397名接受CMR检查的MR患者。CMR用于定性和定量检测PMI。我们还收集了基线临床、超声心动图和随访数据：在 397 名 MR 患者（52.4 ± 13.9 岁）中，117 人（29.5%）被分配到 PMI 组，280 人（70.5%）被分配到非 PMI 组。PMI 在 PM 后内侧（PM-PM，98/117）的表现多于 PM 前外侧（AL-PM，45/117）。与没有 PMI 的患者相比，PMI 患者的 AL-PM （41.5 ± 5.4 vs. 45.6 ± 5.3）/PM-PM 舒张期长度（35.0 ± 5.2 vs. 37.9 ± 4.0）、PM 纵向应变（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）、PM 间距增加（25.7 ± 8.0 vs. 22.7 ± 6.2，均为 p 结论：CMR 导出的 PMI 和 LS 参数改善了 PM 功能障碍的评估，提示了心律失常的高风险，并为 MR 患者提供了额外的风险分层。
Papillary Muscle Infarction by Cardiac MRI in Patients With Mitral Regurgitation
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.
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