Pambianchi Giacomo, Giannetti Martina, Marchitelli Livia, Cundari Giulia, Maestrini Viviana, Mancone Massimo, Francone Marco, Catalano Carlo, Galea Nicola
Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, 00161 Rome, Italy.
Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, "Policlinico Umberto I" Hospital, 00161 Rome, Italy.
J Clin Med. 2023 Feb 14;12(4):1497. doi: 10.3390/jcm12041497.
Papillary muscle (PPM) involvement in myocardial infarction (MI) increases the risk of secondary mitral valve regurgitation or PPM rupture and may be diagnosed using late gadolinium enhancement (LGE) imaging. The native T1-mapping (nT1) technique and PPM longitudinal strain (PPM-ls) have been used to identify PPM infarction (iPPM) without the use of the contrast agent. This study aimed to assess the diagnostic performance of nT1 and PPM-ls in the identification of iPPM. Forty-six patients, who performed CMR within 14-30 days after MI, were retrospectively enrolled: sixteen showed signs of iPPM on LGE images. nT1 values were measured within the infarcted area (IA), remote myocardium (RM), blood pool (BP), and anterolateral and posteromedial PPMs and compared using ANOVA. PPM-ls values have been assessed on cineMR images as the percentage of shortening between end-diastolic and end-systolic phases. Higher nT1 values and lower PPM-ls were found in infarcted compared to non-infarcted PPMs (nT1: 1219.3 ± 102.5 ms vs. 1052.2 ± 80.5 ms and 17.6 ± 6.3% vs. 21.6 ± 4.3%; -value < 0.001 for both), with no significant differences between the nT1 of infarcted PPMs and IA and between the non-infarcted PPMs and RM. ROC analysis demonstrated an excellent discriminatory power for nT1 in detecting the iPPM (AUC = 0.874; 95% CI: 0.784-0.963; < 0.001). nT1 and PPM-ls are valid tools in assessing iPPM with the advantage of avoiding contrast media administration.
乳头肌（PPM）受累于心肌梗死（MI）会增加继发性二尖瓣反流或PPM破裂的风险，并且可以使用延迟钆增强（LGE）成像进行诊断。天然T1映射（nT1）技术和PPM纵向应变（PPM-ls）已被用于在不使用造影剂的情况下识别PPM梗死（iPPM）。本研究旨在评估nT1和PPM-ls在识别iPPM方面的诊断性能。回顾性纳入了46例在MI后14 - 30天内进行心脏磁共振成像（CMR）的患者：16例在LGE图像上显示有iPPM的迹象。在梗死区域（IA）、远隔心肌（RM）、血池（BP）以及前外侧和后内侧PPM内测量nT1值，并使用方差分析进行比较。在电影磁共振图像上评估PPM-ls值，作为舒张末期和收缩末期之间缩短的百分比。与未梗死的PPM相比，梗死的PPM中nT1值更高，PPM-ls更低（nT1：1219.3±102.5毫秒对1052.2±80.5毫秒，17.6±6.3%对21.6±4.3%；两者p值均<0.001），梗死的PPM与IA的nT1之间以及未梗死的PPM与RM的nT1之间无显著差异。ROC分析表明nT1在检测iPPM方面具有出色的辨别能力（曲线下面积[AUC]=0.874；95%置信区间：0.784 - 0.963；p<0.001）。nT1和PPM-ls是评估iPPM的有效工具，具有避免使用造影剂的优点。
