The number of myocardial infarction segments connected to papillary muscle is associated with the improvement in moderate ischemic mitral regurgitation

Figures

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  Figure 1. Transverse chest cardiac magnetic resonance scan and LV segment division. (A) The three white dashed lines divide the LV along its long axis into the basal segment, intermediate segment, and apex segment. The red arrows indicate the PM, and the yellow arrows indicate the myocardium connected to the PM. (B) Segments 1–6 comprise the basal segment, segments 7–12 comprise the intermediate segment, and segments 13–16 comprise the apex segment. The yellow parts (10, 11, 12, 15, and 16) are the five myocardial segments connected to PM. LV, left ventricular; PM, papillary muscle.

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  Figure 2. Flowchart of patient screening. CHD, coronary heart disease; IMR, ischemic mitral regurgitation; CMR, cardiac magnetic resonance; CABG, coronary artery bypass grafting, MVP, mitral valve plasty.

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  Figure 3. Imaging data of a patient with no IMR improvement. (A) LGE short-axis section of the LV. (B) Contour of the LV endocardium and epicardium sketched using software (green is the epicardium, red is the endocardium); the yellow area is the LGE area. (C) Sixteen-segment diagram of the LV show that MI segments connected to PM is 2. (D) Preoperative echocardiogram results. IMR area in the dashed line was 7.8 cm², and EROA was calculated as 0.36 cm². (E) The echocardiogram results at 1 year after operation. IMR area in the dashed line was 8.0 cm², and EROA was calculated as 0.38 cm². LGE, late gadolinium enhancement; IMR, ischemic mitral regurgitation; EROA, effective regurgitation orifice area; RV, right ventricle/ventricular; LV, left ventricle/ventricular; RA, right atrium; LA, left atrium; MI, myocardial infarction; PM, papillary muscle.

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  Figure 4. Imaging data of a patient with IMR improvement. (A) LGE short-axis section of the LV. (B) Contour of the LV endocardium and epicardium sketched using software (green is the epicardium, red is the endocardium); the yellow area is the LGE area. (C) Sixteen-segment diagram of the LV shows that MI segments connected to PM is 0. (D) Preoperative echocardiogram results. IMR area in the dashed line was 7.0 cm², and EROA was calculated as 0.30 cm². (E) The echocardiogram results at 1 year after operation. IMR area in the dashed line was 1.8 cm², and EROA was calculated as 0.08 cm². LGE, late gadolinium enhancement; IMR, ischemic mitral regurgitation; EROA, effective regurgitation orifice area; RV, right ventricle/ventricular; LV, left ventricle/ventricular; RA, right atrium; LA, left atrium; MI, myocardial infarction; PM, papillary muscle.

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  Figure 5. ROC curve analysis. For the prediction of no IMR improvement after isolated CABG, the optimal cut-off value for MI segments connected to PM was 2. IMR, ischemic mitral regurgitation; CABG, coronary artery bypass grafting; MI, myocardial infarction; PM, papillary muscle; AUC, area under the curve; ROC, receiver operating characteristic.

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  Figure 6. MACCEs-free survival curve plotted using the Kaplan-Meier method (log-rank test, P=0.041). MACCEs, major adverse cardiovascular and cerebrovascular events; CI, confidence interval.