Papillary muscle infarction and cardiovascular outcomes
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Papillary muscle infarction and cardiovascular outcomes Geetha P Bhumireddy1*, Nikolas Krishna1, Nripen Donneti1, On Chen1, Ijaz Ahmad2, Quaratal Jamell2, Joshua Socolow1, Sorin J Brener2, Igor Klem3, Joshua Fogel1, Terrence Sacchi1, John F Heitner1 From 2011 SCMR/Euro CMR Joint Scientific Sessions Nice, France. 3-6 February 2011 Introduction Recent studies suggest that papillary muscle infarction (PMI) detected by contrast enhancement cardiac magnetic resonance (ce-CMR) may correlate with mitral regurgitation and reduced left ventricular ejection fraction (LVEF). However, there is scant data about the association of PMI with cardiovascular outcomes. Purpose To determine the prognostic significance of PMI, detected by ce-CMR, in patients with ischemic (ICM) and non-ischemic cardiomyopathy (NICM). Methods We evaluated the images of 456 consecutive patients who underwent ce-CMR for the assessment of left ventricular function and viability. PMI (both anterolateral and postero-medial papillary muscles), ICM and NICM were assessed by visual assessment by interpreters blinded to clinical data. All patients had a LVEF ≤50%. ICM and NICM were determined by presence and pattern of hyper-enhancement. Patients were followed by telephone interview for the following outcomes: all-cause mortality, exacerbation of CHF, defined as a decrease in NYHA functional class, myocardial infarction or re-hospitalization due to a cardiac etiology. Results Our study population consisted of 320 patients with ICM and 136 with NICM (mean age: 63 years; males:
66%). The prevalence of PMI was 66% and 12% in the ICM and NICM patients, respectively. There was a higher prevalence of postero-medial PMI compared to antero-lateral PMI in both the ICM and NICM (66% vs. 30% and 63% vs. 38% respectively). Mean follow up was 2.8 ± 1.8 years. Presence of PMI was associated with a significantly higher incidence of all-cause mortality and cardiovascular outcomes (11% vs. 4%, p=0.02 and 54% vs. 42% p=0.009, respectively). Patients with both papillary muscles infarcted had a higher incidence of all-cause mortality and cardiovascular outcomes compared to patients with no PMI (30% vs. 4%, p
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