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Abnormal papillary muscle signal on cine CMR images in mitral valve prolapse

Session Poster session 2

Speaker Alessandra Scatteia

Event : EuroCMR 2019

  • Topic : imaging
  • Sub-topic : Cardiac Magnetic Resonance: Valve Disease
  • Session type : Poster Session

Authors : A Scatteia (Naples,IT), CE Pascale (Naples,IT), P Guarini (Naples,IT), S Dellegrottaglie (Naples,IT)

A Scatteia1 , CE Pascale1 , P Guarini1 , S Dellegrottaglie1 , 1Villa dei Fiori Hospital - Naples - Italy ,

European Heart Journal - Cardiovascular Imaging ( 2019 ) 20 ( Supplement 2 ), ii349


In mitral valve prolapse (MVP) increasing attention has been recently devoted to the complex pathophysiology involving mitral leaflets, sub-valvular apparatus and left ventricle (LV), searching for potential explanations to the increased symptomatic ventricular arrhythmic events observed in this condition.


In this study, we used standard CMR cine images in MVP to investigate signal characteristics of LV papillary muscles and to verify association with ventricular arrhythmias.


A total of 47 patients with MVP (16-84 years; 68% female) were retrospectively recruited. Groups including healthy volunteers (HV; N = 16), patients with moderate-to-severe secondary mitral regurgitation (MR; N = 24) and with hypertrophic cardiomyopathy (HCM; N = 25) were also considered for comparisons. CMR acquisition included cine steady state free precession (SSFP) images as well as 2D and 3D post-contrast images in conventional long-axis and short-axis planes. Late gadolinium enhancement (LGE) involving the papillary muscles was qualitatively assessed. All CMR studies were analyzed using a commercially available software. A mid-ventricular end-systolic short-axis cine SSFP image was selected to measure SI in antero-lateral and postero-medial papillary muscles by manually drawing an appropriate region of interest (ROI). In the same slice, a ROI in the interventricular septum was used to assess LV myocardial SI (Figure 1 A). Antero-lateral and postero-medial papillary muscle SI were indexed for LV SI (AL/LV SI and PM/LV SI, respectively). MVP population was also split into arrhythmic (clear documentation of ventricular complex tachyarrhythmia) and non-arrhythmic groups.


The MVP group displayed lower AL/LV (0,7±0,2) and PM/LV (0,7±0,2) SI values as compared to healthy controls (1,1±0,1 and 1,0±0,2, respectively, Figure 1 B) and compared to MR and HCM groups (p<0,001 form MVP vs any other group; Figure 1 C-D). ROC curves provided best cut-off values for identification of MVP patients (AL/LV SI = 0,8, AUC = 0.98; 100% sensibility and 80% specificity and PM/LV SI = 0,7, AUC = 0,94; 100% sensibility and 63% specificity). Convincing areas of pupillary muscle LGE could not be identified in any of the MVP patient. No significant differences in AL/AV and PM/LV SI were noted between arrhythmic (N = 7) and non-arrhythmic (N = 40) MVP groups (p>0,4).

Conclusion On cine CMR images, LV papillary muscle signal is typically abnormal in MVP patients and a reduced papillary muscle SI can accurately differentiate MVP from healthy controls and other conditions potentially involving the mitral sub-valvular apparatus. Apparently, this novel imaging marker is not related to the documentation of gross papillary muscles fibrosis and the occurrence of ventricular arrhythmias.

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