Late Gadolinium Enhancement of Left Ventricular Papillary Muscles in Patients with Mitral Regurgitation
Key result
Papillary muscle LGE is linked to ~7-fold higher ventricular arrhythmia risk in mitral regurgitation.
- OR 6.84
- 95% CI 1.29-36.19
- P=0.024
- n=88
Why the study?
Papillary muscle late gadolinium enhancement (LGE) may occur in non-MVP mitral regurgitation, but its association with ventricular arrhythmia across mitral regurgitation etiologies is unclear.
Is late gadolinium enhancement of the papillary muscles on CMR associated with ventricular arrhythmia in patients with mitral regurgitation?
Population
88 patients with mitral regurgitation who underwent CMR
Comparison
MVP (n = 43) vs non-MVP (n = 45)
Design
Observational comparative study
Authors
Discussion
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Member takes
Implication
Papillary muscle LGE may flag higher arrhythmia risk in mitral regurgitation; hypothesis-generating and should not yet change practice.
Study Design
Type
Observational (n=88)
Multicenter
No
Structured PICO
Is late gadolinium enhancement of the papillary muscles on CMR associated with ventricular arrhythmia in patients with mitral regurgitation?
P
Population
88 patients with mitral regurgitation who underwent CMR, mean age 58.3 ± 12.0 years, 42% male. Divided into MVP (n=43) and non-MVP (n=45) groups.
I
Intervention
Cardiac magnetic resonance imaging (CMR) to assess late gadolinium enhancement (LGE) of the LV papillary muscles or ventricular wall
O
Outcome
Association of LGE of the LV papillary muscles or ventricular wall on CMR and ventricular arrhythmiasurrogate
Main Result
Effect estimate: OR 6.84 (95% CI 1.29-36.19)
p-value: p=0.024
In patients with mitral regurgitation, late gadolinium enhancement of the papillary muscles on CMR is significantly associated with ventricular arrhythmia.
Limitations
- Retrospective design at a single tertiary center, suggesting possible selection bias
- Not all patients with ventricular arrhythmia or sudden cardiac death underwent CMR, potentially underestimating LGE prevalence
- Exclusion of patients with mild mitral regurgitation
- Inclusion of patients with concomitant tricuspid regurgitation
- Small sample size of patients with LGE of the papillary muscles resulting in wide confidence intervals
Cite This Study
Lim et al. (2021) conducted an observational in Mitral regurgitation (n=88). Late gadolinium enhancement of papillary muscles vs. No late gadolinium enhancement was evaluated on Ventricular arrhythmia (OR 6.84, 95% CI 1.29-36.19, p=0.024). Late gadolinium enhancement of the papillary muscles was significantly associated with ventricular arrhythmia (OR 6.84) in patients with mitral regurgitation.