Is There an Alternative Explanation to Post-Myocardial Infarction Emergence of Mitral Regurgitation? A CMR-LGE Observational Study
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Hari Bogabathina, Mark Doyle, Ronald Williams, June Yamrozik, Diane Vido, Robert W. W. Biederman Department of Cardiovascular Magnetic Resonance, Gerald McGinnis Cardiovascular Institute, Allegheny General Hospital, Pittsburgh, PA, USA |
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Background and aim of the study: Post-myocardial infarction (MI) mitral regurgitation (MR) is thought to be due to a passive, rather than active, remodelling of the mitral valve apparatus and its relationship with other cardiac structures that contribute to MR. Standard contrast-enhanced magnetic resonance (CMR) late gadolinium enhancement (LGE) may be sensitive to non-myocardial pathology involving the mitral valve leaflets. It was hypothesized that the presence of mitral valve enhancement (MVE) on LGE imaging in post-MI patients would be associated with an increased incidence of MR. Methods: The presence or absence of MVE was noted in patients presenting for CMR with MI and non-MI indications requiring LGE. A chi-square analysis was performed for non-contiguous variables; SPSS (Chicago) software was utilized for the statistical analysis. Results: Eighty-seven patients (54 males, 33 females) underwent LGE-CMR studies utilizing a 1.5 T GE scanner with MultiHance gadolinium contrast administration. LGE+ |
(present) was noted in 68 patients, and LGE- (absent) in 19 patients. Post-MI patterns of LGE+ were noted in 51 patients and LGE- in 36 patients; MVE+ was noted in 39 patients and MVE- in 48; and MR+ was present in 67 patients and absent (MR-) in 20 patients. MVE was observed chiefly in post-MI patients (33/51; 65%) and infrequently in non-post-MI patients (6/36; 17%; χ2 = 17.8, p <0.001, power = 0.995). Further, MR was present more frequently in patients with MVE (36/39; 92%) compared to patients without MVE (31/48; 65%; χ2 = 7.8, p = 0.005, power = 0.814). Conclusion: MVE is present in a large number of post-MI patients but rarely in non-post-MI patients. Post-MI patients with, rather than without, MVE are far more likely to have MR. These observations suggest a specific but as-yet unknown reactive process that may contribute to mitral leaflet remodelling in post-MI patients, potentially contributing to an increased incidence of MR in post-MI patients.The Journal of Heart Valve Disease 2013;22:669-674 |
| Is There an Alternative Explanation to Post-Myocardial Infarction Emergence of Mitral Regurgitation? A CMR-LGE Observational Study | |
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