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. 2021 Oct;22(10):1609-1618.
doi: 10.3348/kjr.2020.1485. Epub 2021 Jul 26.

Late Gadolinium Enhancement of Left Ventricular Papillary Muscles in Patients with Mitral Regurgitation

Su Jin Lim  1 , Hyun Jung Koo  2 , Min Soo Cho  3 , Gi-Byoung Nam  3 , Joon-Won Kang  1 , Dong Hyun Yang  1
Affiliations

Late Gadolinium Enhancement of Left Ventricular Papillary Muscles in Patients with Mitral Regurgitation

Su Jin Lim et al. Korean J Radiol. 2021 Oct.

Abstract

Objective: Arrhythmogenic mitral valve prolapse (MVP) is an important cause of sudden cardiac death characterized by fibrosis of the papillary muscles or left ventricle (LV) wall, and an association between late gadolinium enhancement (LGE) of the LV papillary muscles and ventricular arrhythmia in MVP has been reported. However, LGE of the papillary muscles may be observed in other causes of mitral regurgitation, and it is not limited to patients with MVP. This study was to evaluate the association of LGE of the LV papillary muscles or ventricular wall on cardiac magnetic resonance imaging (CMR) and ventricular arrhythmia in patients with mitral regurgitation.

Materials and methods: This study included 88 patients (mean age ± standard deviation, 58.3 ± 12.0 years; male, 42%) with mitral regurgitation who underwent CMR. They were allocated to the MVP (n = 43) and non-MVP (n = 45) groups, and their LGE images on CMR, clinical characteristics, echocardiographic findings, and presence of arrhythmia were compared.

Results: LV myocardial wall enhancement was more frequent in the MVP group than in the non-MVP group (28% vs. 11%, p = 0.046). Papillary muscle enhancement was observed in 7 (7.9%) patients. Of the 43 patients with MVP, 15 (34.8%) showed LGE in the papillary muscles or LV myocardium, including 12 (27.9%) with LV myocardial wall enhancement and 4 (9.3%) with papillary muscle enhancement. One patient with bilateral diffuse papillary muscle enhancement experienced sudden cardiac arrest due to ventricular fibrillation. Univariable logistic regression analysis showed that high systolic blood pressure (BP; odds ratio [OR], 1.05; 95% confidence interval [CI], 1.01-1.09; p = 0.027) and ventricular arrhythmia (OR, 6.84; 95% CI, 1.29-36.19; p = 0.024) were significantly associated with LGE of the papillary muscles.

Conclusion: LGE of the papillary muscles was present not only in patients with MVP, but also in patients with other etiologies of mitral regurgitation, and it was associated with high systolic BP and ventricular arrhythmia. Papillary muscle enhancement on CMR should not be overlooked.

Keywords: Arrhythmia; Late gadolinium enhancement; Mitral regurgitation; Mitral valve prolapse.

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Conflict of interest statement

The authors have no potential conflicts of interest to disclose.

Figures

Fig. 1
Fig. 1. Study flow chart.
CMR = cardiac magnetic resonance imaging, MVP = mitral valve prolapse, TR = tricuspid regurgitation
Fig. 2
Fig. 2. CMR images of a 48-year-old male with no previous medical history, except for dyslipidemia, who presented with convulsion and loss of consciousness.
A-C. Event electrocardiography monitor in the ambulance showed ventricular fibrillation, and the patient was resuscitated after defibrillation. Echocardiography showed severe mitral regurgitation due to diffuse prolapse of the anterior mitral leaflet. Short-axis view (A), four-chamber view (B), and two-chamber view (C) of CMR images showing intense enhancement of both papillary muscles. The patient was treated with implantable cardioverter-defibrillator insertion and mitral valve repair. CMR = cardiac magnetic resonance imaging
See this image and copyright information in PMC

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References

    1. Hinton RB, Yutzey KE. Heart valve structure and function in development and disease. Annu Rev Physiol. 2011;73:29–46. - PMC - PubMed
    1. La Vecchia L, Ometto R, Centofante P, Varotto L, Bonanno C, Bozzola L, et al. Arrhythmic profile, ventricular function, and histomorphometric findings in patients with idiopathic ventricular tachycardia and mitral valve prolapse: clinical and prognostic evaluation. Clin Cardiol. 1998;21:731–735. - PMC - PubMed
    1. Chen HY. Relationship of heart rate turbulence, heart rate variability and the number of ventricular premature beats in patients with mitral valve prolapse and non-significant regurgitation. Int J Cardiol. 2009;135:269–271. - PubMed
    1. Turker Y, Ozaydin M, Acar G, Ozgul M, Hoscan Y, Varol E, et al. Predictors of ventricular arrhythmias in patients with mitral valve prolapse. Int J Cardiovasc Imaging. 2010;26:139–145. - PubMed
    1. Narayanan K, Uy-Evanado A, Teodorescu C, Reinier K, Nichols GA, Gunson K, et al. Mitral valve prolapse and sudden cardiac arrest in the community. Heart Rhythm. 2016;13:498–503. - PMC - PubMed