DOI QR코드

DOI QR Code

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

  • Su Jin Lim (Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Hyun Jung Koo (Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Min Soo Cho (Department of Internal Medicine, Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Gi-Byoung Nam (Department of Internal Medicine, Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Joon-Won Kang (Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Dong Hyun Yang (Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine)
  • 투고 : 2020.09.24
  • 심사 : 2021.03.21
  • 발행 : 2021.10.01

초록

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.

키워드

참고문헌

  1. Hinton RB, Yutzey KE. Heart valve structure and function in development and disease. Annu Rev Physiol 2011;73:29-46  https://doi.org/10.1146/annurev-physiol-012110-142145
  2. 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  https://doi.org/10.1002/clc.4960211007
  3. 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  https://doi.org/10.1016/j.ijcard.2008.03.060
  4. 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  https://doi.org/10.1007/s10554-009-9514-6
  5. 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  https://doi.org/10.1016/j.hrthm.2015.09.026
  6. Han Y, Peters DC, Salton CJ, Bzymek D, Nezafat R, Goddu B, et al. Cardiovascular magnetic resonance characterization of mitral valve prolapse. JACC Cardiovasc Imaging 2008;1:294-303  https://doi.org/10.1016/j.jcmg.2008.01.013
  7. Basso C, Perazzolo Marra M, Rizzo S, De Lazzari M, Giorgi B, Cipriani A, et al. Arrhythmic mitral valve prolapse and sudden cardiac death. Circulation 2015;132:556-566  https://doi.org/10.1161/CIRCULATIONAHA.115.016291
  8. Fulton BL, Liang JJ, Enriquez A, Garcia FC, Supple GE, Riley MP, et al. Imaging characteristics of papillary muscle site of origin of ventricular arrhythmias in patients with mitral valve prolapse. J Cardiovasc Electrophysiol 2018;29:146-153  https://doi.org/10.1111/jce.13374
  9. Chesler E, King RA, Edwards JE. The myxomatous mitral valve and sudden death. Circulation 1983;67:632-639  https://doi.org/10.1161/01.CIR.67.3.632
  10. Farb A, Tang AL, Atkinson JB, McCarthy WF, Virmani R. Comparison of cardiac findings in patients with mitral valve prolapse who die suddenly to those who have congestive heart failure from mitral regurgitation and to those with fatal noncardiac conditions. Am J Cardiol 1992;70:234-239  https://doi.org/10.1016/0002-9149(92)91281-8
  11. Sniezek-Maciejewska M, Dubiel JP, Piwowarska W, Mroczek-Czernecka D, Mazurek S, Jaskiewicz J, et al. Ventricular arrhythmias and the autonomic tone in patients with mitral valve prolapse. Clin Cardiol 1992;15:720-724  https://doi.org/10.1002/clc.4960151029
  12. Wilde AA, Duren DR, Hauer RN, deBakker JM, Bakker PF, Becker AE, et al. Mitral valve prolapse and ventricular arrhythmias: observations in a patient with a 20-year history. J Cardiovasc Electrophysiol 1997;8:307-316  https://doi.org/10.1111/j.1540-8167.1997.tb00793.x
  13. Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 2015;16:233-270  https://doi.org/10.1093/ehjci/jev014
  14. Gillam LD. Is it time to update the definition of functional mitral regurgitation?: structural changes in the mitral leaflets with left ventricular dysfunction. Circulation 2008;118:797-799  https://doi.org/10.1161/CIRCULATIONAHA.108.795781
  15. Lown B, Wolf M. Approaches to sudden death from coronary heart disease. Circulation 1971;44:130-142  https://doi.org/10.1161/01.CIR.44.1.130
  16. Kim RJ, Shah DJ, Judd RM. How we perform delayed enhancement imaging. J Cardiovasc Magn Reson 2003;5:505-514  https://doi.org/10.1081/JCMR-120022267
  17. Han Y, Peters DC, Kissinger KV, Goddu B, Yeon SB, Manning WJ, et al. Evaluation of papillary muscle function using cardiovascular magnetic resonance imaging in mitral valve prolapse. Am J Cardiol 2010;106:243-248  https://doi.org/10.1016/j.amjcard.2010.02.035
  18. Enriquez A, Shirai Y, Huang J, Liang J, Briceno D, Hayashi T, et al. Papillary muscle ventricular arrhythmias in patients with arrhythmic mitral valve prolapse: electrophysiologic substrate and catheter ablation outcomes. J Cardiovasc Electrophysiol 2019;30:827-835  https://doi.org/10.1111/jce.13900
  19. Kitkungvan D, Nabi F, Kim RJ, Bonow RO, Khan MA, Xu J, et al. Myocardial fibrosis in patients with primary mitral regurgitation with and without prolapse. J Am Coll Cardiol 2018:72;823-834  https://doi.org/10.1016/j.jacc.2018.06.048
  20. Shiran A, Sagie A. Tricuspid regurgitation in mitral valve disease incidence, prognostic implications, mechanism, and management. J Am Coll Cardiol 2009;53:401-408  https://doi.org/10.1016/j.jacc.2008.09.048
  21. Rudolph A, Abdel-Aty H, Bohl S, Boye P, Zagrosek A, Dietz R, et al. Noninvasive detection of fibrosis applying contrast-enhanced cardiac magnetic resonance in different forms of left ventricular hypertrophy relation to remodeling. J Am Coll Cardiol 2009;53:284-291 https://doi.org/10.1016/j.jacc.2008.08.064