Myocardial infarction with necrosis of the papillary muscles of the left ventricle more often leads to death – Society

The INCLIVA Health Research Institute of the University Teaching Hospital of Valencia took part in a study which concluded that in patients with acute myocardial infarction who have a certain degree of necrosis (tissue death) in the papillary muscles of the left ventricle, detected by MRI hearts. Magnetic resonance imaging has a higher likelihood of death, arrhythmias and heart failure in the long term.

Coronary heart disease includes a complex of pathologies characterized by insufficient oxygen supply to the heart compared to needs. In particular, acute myocardial infarction is a sudden occlusion of a coronary artery, usually due to a blood clot, and is a pathology commonly encountered in Western countries.

After a heart attack, 15 to 40 percent of patients have some degree of necrosis of the papillary muscles of the left ventricle of the heart. In the short term (1 year), the presence of necrosis in this area was associated with an increased incidence of adverse cardiovascular events such as death or heart failure. However, it is unclear whether this negative effect will persist in the long term, and the mechanisms leading to this frequency of events have not been determined.

This multicentre study, published in the journal JACC Cardiovascular Imaging, included 1055 patients with a first acute myocardial infarction from the University Hospital of Valencia and Hospitals Clínica and Vall d’Hebron in Barcelona, ​​based on a joint registry of three hospitals for more than five years.

These patients underwent cardiac magnetic resonance imaging one week after infarction and were followed for clinical development for an average of 6.5 to 4.4 years.

The use of magnetic resonance imaging, the modality of choice for assessing cardiac damage after a heart attack, has been critical in identifying and characterizing the extent of papillary muscle damage. In 351 patients (33%), necrosis was observed in the papillary muscles (manifested by a zone of contrast retention in these muscles, in the area of ​​attachment of the mitral valve to the walls of the left ventricle). ).

Patients in whom this sign was detected had more depressed contractile function and a larger infarct size in the left ventricle. Likewise, the presence of papillary muscle damage was associated with higher rates of cardiovascular mortality and heart failure. Interestingly, a higher incidence of serious arrhythmias was found in patients who were found to have this feature.

This project was funded thanks to the Carlos III Institute of Health, CIBERCV, the Regional Development Fund (FEDER) and the Generalitat of Valencia through the PROMETEO program for advanced research groups in the Valencian Community.