Prognostic relevance of papillary muscle infarction in reperfused infarction as visualized by cardiovascular magnetic resonance

Ingo Eitel*, Dörthe Gehmlich, Omran Amer, Jochen Wöhrle, Sebastian Kerber, Bernward Lauer, Matthias Pauschinger, Johannes Schwab, Ralf Birkemeyer, Rainer Zimmermann, Meinhard Mende, Suzanne De Waha, Steffen Desch, Matthias Gutberlet, Gerhard Schuler, Holger Thiele

*Corresponding author for this work
22 Citations (Scopus)

Abstract

Background-The prognostic significance of papillary muscle infarction (PapMI) on hard clinical outcomes has not been investigated in patients with reperfused ST-segment-elevation myocardial infarction. Noninvasive investigation by gadolinium-enhanced cardiac MRI enables the detection of PapMI with high spatial resolution. The aim of our study was (1) to assess the incidence, determinants, and clinical characteristics of PapMI in a large multicenter cohort of patients with ST-segment-elevation myocardial infarction and (2) to assess the prognostic significance of PapMI at 1-year follow-up. Methods and Results-We enrolled 738 patients with ST-segment-elevation myocardial infarction reperfused by primary angioplasty (<12 hours after symptom onset) in this cardiac MRI study at 8 centers. Cardiac MRI was completed within 1 week after infarction using a standardized protocol. Central core laboratory-masked analyses for the presence of PapMI were performed. The primary clinical end point of the study was the occurrence of major adverse cardiac events. PapMIs were detected in 104 patients (14%). The presence of PapMI was associated with larger infarcts (P<0.001), less myocardial salvage (P<0.001), impaired left ventricular function (P<0.001), and more pronounced reperfusion injury (P=0.02). Patients with PapMI had a significantly higher mortality (8 [7.7%] versus 12 [1.9%]) and major adverse cardiac events (21 [20.2%] versus 31 [4.9%]) rate at 12-month follow-up (P<0.001, respectively). PapMI was identified as a significant independent predictor of major adverse cardiac events (hazard ratio, 4.41 [confidence interval, 2.54-7.68]; P<0.001).

Original languageEnglish
JournalCirculation: Cardiovascular Imaging
Volume6
Issue number6
Pages (from-to)890-898
Number of pages9
ISSN1941-9651
DOIs
Publication statusPublished - 11.2013

Research Areas and Centers

  • Centers: Cardiological Center Luebeck (UHZL)

DFG Research Classification Scheme

  • 205-12 Cardiology, Angiology

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