Cau Riccardo, Pinna Alessandro, Montisci Roberta, d'Errico Luigia, Suri Jasjit S, Francone Marco, Muscogiuri Giuseppe, Saba Luca
Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari - Polo di Monserrato s.s. 554 Monserrato (Cagliari), Monserrato, 09045, Italy.
Department of Cardiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari - Polo di Monserrato s.s. 554 Monserrato (Cagliari), Monserrato, 09045, Italy.
Int J Cardiovasc Imaging. 2025 Feb;41(2):359-368. doi: 10.1007/s10554-024-03317-2. Epub 2025 Jan 18.
The purpose of this study was to explore the impact of papillary muscle (PPM) infarction on left atrial and ventricular strain parameters in patients with non-anterior ST-segment elevation myocardial infarction (NA-STEMI) using cardiovascular magnetic resonance (CMR). This retrospective study performed CMR scans on 88 consecutive patients with NA-STEMI (68 males, 65 ± 10.05 years). Among them, 30 demonstrated PPM infarction (25 males, 67.12 ± 9.49 years), defined as late gadolinium enhancement (LGE) in a papillary muscle head in two contiguous LGE CMR slices, and confirmed on the long-axis LGE CMR slices. Atrial and ventricular strain were analyzed by CMR feature tracking with dedicated post-processing software. Patients with PPM infarction were older (p = 0.001), with lower left ventricular ejection fraction (p = 0.040), higher indexed left ventricular end-diastolic volume (p = 0.020), and end-systolic volume (p = 0.044) compared to patients without LGE in the papillary muscle. Additionally, patients with PPM infarction showed impaired reservoir strain, booster strain, global longitudinal strain (GLS), and higher LGE extent compared to NA-STEMI patients without PPM involvement (p = 0.001, p = 0.004, p = 0.001, and p = 0.003, respectively). In multivariable analysis, GLS, global radial strain, reservoir strain, and booster strain parameters were the only independent determinants of PPM infarction (p = 0.001, p = 0.041, p = 0.002, and p = 0.027, respectively). The presence of PPM infarction assessed by CMR is independently linked to atrial and ventricular strain impairment in patients with NA-STEMI.
本研究的目的是利用心血管磁共振成像（CMR）探讨乳头肌梗死对非前壁ST段抬高型心肌梗死（NA-STEMI）患者左心房和心室应变参数的影响。这项回顾性研究对88例连续的NA-STEMI患者（68例男性，年龄65±10.05岁）进行了CMR扫描。其中，30例显示乳头肌梗死（25例男性，年龄67.12±9.49岁），定义为在两个连续的CMR钆延迟增强（LGE）切片中乳头肌头部出现LGE，并在长轴LGE CMR切片上得到证实。通过使用专用后处理软件的CMR特征跟踪分析心房和心室应变。与乳头肌无LGE的患者相比，乳头肌梗死患者年龄更大（p = 0.001），左心室射血分数更低（p = 0.040），左心室指数舒张末期容积更高（p = 0.020），收缩末期容积更高（p = 0.044）。此外，与未累及乳头肌的NA-STEMI患者相比，乳头肌梗死患者的储备应变、增强应变、整体纵向应变（GLS）受损，LGE范围更大（分别为p = 0.001、p = 0.004、p = 0.001和p = 0.003）。在多变量分析中，GLS、整体径向应变、储备应变和增强应变参数是乳头肌梗死的唯一独立决定因素（分别为p = 0.001、p = 0.041、p = 0.002和p = 0.027）。通过CMR评估的乳头肌梗死的存在与NA-STEMI患者的心房和心室应变受损独立相关。
