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Open Access 24-01-2023 | Sudden Cardiac Death | Cardiac

Dark papillary muscles sign: a novel prognostic marker for cardiac magnetic resonance

Authors: Giovanni Donato Aquaro, Carmelo De Gori, Giulia Grilli, Roberto Licordari, Andrea Barison, Giancarlo Todiere, Umberto Ianni, Matteo Parollo, Crysanthos Grigoratos, Luca Restivo, Antonio De Luca, Lorenzo Faggioni, Dania Cioni, Gianfranco Sinagra, Gianluca Di Bella, Emanuele Neri

Published in: European Radiology | Issue 7/2023

Abstract

Objectives

The prognostic role of left ventricular (LV) papillary muscle abnormalities in patients with preserved LV systolic ejection fraction (LVEF) is unknown. We sought to evaluate the prognosis role of LV papillary muscle abnormalities by CMR in patients with ventricular arrhythmias, preserved LVEF with no cardiac disease.

Methods

A total of 391 patients with > 500/24 h premature ventricular complexes and/or with non-sustained ventricular tachycardia (NSVT), preserved LVEF, and no cardiac disease were enrolled. Different features of LV papillary muscles were considered: supernumerary muscles, papillary thickness, the attachment, late gadolinium enhancement (LGE). Dark-Paps was defined as end-systolic signal hypointensity of both papillary muscles in early post-contrast cine CMR images. Mitral valve prolapse, mitral annular disjunction (MAD), and myocardial LGE were considered.

Results

Dark-Paps was found in 79 (20%) patients and was more frequent in females. It was associated with higher prevalence of mitral valve prolapse and MAD. During a median follow-up of 2534 days, 22 hard cardiac events occurred. At Kaplan-Meier curve analysis, patients with Dark-Paps were at higher risk of events than those without (p < 0.0001). Dark-Paps was significantly associated with hard cardiac events in all the multivariate models. Dark-Paps improved prognostic estimation when added to NSVT (p = 0.0006), to LGE (p = 0.005) and to a model including NSVT+LGE (p = 0.014). Dark-Paps allowed a significant net reclassification when added to NSVT (NRI 0.30, p = 0.03), to LGE (NRI 0.25, p = 0.04), and to NSVT + LGE (NRI 0.32, p = 0.02).

Conclusions

In LV papillary muscles, Dark-Paps is a novel prognostic marker in patients with ventricular arrhythmias and preserved ejection fraction.

Key Points

• Papillary muscle abnormalities are seen in patients with ventricular arrhythmias and preserved left ventricular ejection fraction.

• Early post-contrast hypointensity of papillary muscles in end-systolic cine images (Dark-Paps) is a novel prognostic marker in patients with ventricular arrhythmias and preserved ejection fraction.

• Dark-Paps had an additive prognostic role over late gadolinium enhancement and non-sustained ventricular tachycardia.

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Title: Dark papillary muscles sign: a novel prognostic marker for cardiac magnetic resonance
Authors: Giovanni Donato Aquaro
Carmelo De Gori
Giulia Grilli
Roberto Licordari
Andrea Barison
Giancarlo Todiere
Umberto Ianni
Matteo Parollo
Crysanthos Grigoratos
Luca Restivo
Antonio De Luca
Lorenzo Faggioni
Dania Cioni
Gianfranco Sinagra
Gianluca Di Bella
Emanuele Neri
Publication date: 24-01-2023
Publisher: Springer Berlin Heidelberg
Keywords: Sudden Cardiac Death
Ventricular Tachycardia
Published in: European Radiology / Issue 7/2023
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-023-09400-x

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Springer Medicine

Dark papillary muscles sign: a novel prognostic marker for cardiac magnetic resonance

Abstract

Objectives

Methods

Results

Conclusions

Key Points

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusions

Key Points

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