Prevalence and Prognostic Value of Papillary Muscle
Infarction in Patients with Previous Myocardial Infarction
Rungroj Krittayaphong MD1, Prajak Tanapibunpon MSc2, Supapon Nakyen MSc2, Wilasinee Phromawan MBA1
Affiliation :
1 Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
2 Her Majesty Cardiac Center, Faculty of Medicine, Siriraj Hospital Mahidol University, Bangkok, Thailand
Objective : To determine the prevalence and prognostic value of papillary muscle infarction.
Materials and Methods : The authors studied patients who were referred for cardiac magnetic resonance [CMR] for assessment of
myocardial ischemia or myocardial viability and found to have previous myocardial infarction. CMR was performed for assessment
of cardiac function and late gadolinium enhancement [LGE], including detection and quanti(cid:976)ication of mitral regurgitation. Patients
were followed for cardiac events, including cardiac death, nonfatal myocardial infarction, and hospitalization due to heart failure.
Results : The authors studied 785 patients with previous myocardial infarction. Average age was 64.8 years. Papillary muscle infarction
was found in 305 patients (38.9%). Papillary muscle infarction was associated with an increase in left ventricular volumes, mass,
wall motion score, LGE percentages, and mitral regurgitation. Patients with papillary muscle infarction had increased risk of cardiac
event during follow-up. Multivariable analysis showed that left ventricular end-systolic volume index and mitral regurgitation were
independent predictors for cardiac event.
Conclusion : Papillary muscle infarction is not an uncommon condition. It was found to be associated with more severe left
ventricular dysfunction. The increased risk associated with papillary muscle infarction was mediated by more severe myocardial
damage and mitral regurgitation.
Keywords : Papillary muscle, Myocardial infarction, Late gadolinium enhancement, Cardiac magnetic resonance
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