Key result
Although the prevalence of chronic ischemic mitral regurgitation was significantly higher in patients with papillary muscle infarction compared to those without (52% vs 27%), papillary muscle infarction was not an independent predictor of CIMR.
Why the study?
What are the independent predictors of papillary muscle infarction and chronic ischemic mitral regurgitation 4 months after primary PCI for STEMI?
Observational (n=263)
Blinded operators for MRI analysis
No
What are the independent predictors of papillary muscle infarction and chronic ischemic mitral regurgitation 4 months after primary PCI for STEMI?
In patients 4 months post-STEMI, tethering height and interpapillary muscle distance, rather than papillary muscle infarction itself, are the strongest independent predictors of chronic ischemic mitral regurgitation.
BACKGROUND: Both papillary muscle infarction (PMI) and chronic ischemic mitral regurgitation (CIMR) are associated with reduced survival after myocardial infarction. The influence of PMI on CIMR and factors influencing both entities are incompletely understood. OBJECTIVES: We sought to determine the influence of PMI on CIMR after primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) and to define independent predictors of PMI and CIMR. METHODS: Between January 2011 and May 2013, 263 patients (mean age 57.8 ± 11.5 years) underwent late gadolinium-enhanced cardiac magnetic resonance imaging and transthoracic echocardiography 4 months after PCI for STEMI. Infarct size, PMI, and mitral valve and left ventricular geometric and functional parameters were assessed. Univariate and multivariate analyses were performed to identify predictors of PMI and CIMR (≥grade 2+). RESULTS: PMI was present in 61 patients (23 %) and CIMR was present in 86 patients (33 %). In patients with PMI, 52 % had CIMR, and in patients without PMI, 27 % had CIMR (P < 0.001). In multivariate analyses, infarct size [odds ratio (OR) 1.09 (95 % confidence interval 1.04-1.13), P < 0.001], inferior MI [OR 4.64 (1.04-20.62), P = 0.044], and circumflex infarct-related artery [OR 8.21 (3.80-17.74), P < 0.001] were independent predictors of PMI. Age [OR 1.08 (1.04-1.11), P < 0.001], infarct size [OR 1.09 (1.03-1.16), P = 0.003], tethering height [OR 19.30 (3.28-113.61), P = 0.001], and interpapillary muscle distance [OR 3.32 (1.31-8.42), P = 0.011] were independent predictors of CIMR. CONCLUSIONS: The risk of PMI is mainly associated with inferior infarction and infarction in the circumflex coronary artery. Although the prevalence of CIMR is almost doubled in the presence of PMI, PMI is not an independent predictor of CIMR. Tethering height and interpapillary muscle distance are the strongest independent predictors of CIMR.
No takes yet. Share an insight, caveat, or question.
Bouma et al. (2016) conducted an observational in ST-segment elevation myocardial infarction (STEMI) (n=263). Papillary muscle infarction (PMI) vs. No papillary muscle infarction was evaluated on Chronic ischemic mitral regurgitation (CIMR) (p=<0.001). Although the prevalence of chronic ischemic mitral regurgitation was significantly higher in patients with papillary muscle infarction compared to those without (52% vs 27%), papillary muscle infarction was not an independent predictor of CIMR.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: