ArticleJACC. Cardiovascular imaging2021
Ischemia-Mediated Dysfunction in Subpapillary Myocardium as a Marker of Functional Mitral Regurgitation.
Article in JACC. Cardiovascular imaging, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers.
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Who cites it
12 citing papers in PubMed, 19 citations in OpenAlex.
- Evaluation of Left Ventricular Papillary Muscles Using Targeted Views by Echocardiography.Journal of clinical medicine · 2026Article
- Dynamic microRNA Signatures as Biomarkers for Cardiac Ischemia and Remodeling.International journal of molecular sciences · 2026Article
- Nonischemic Septal Fibrosis in Functional Tricuspid Regurgitation Provides Incremental Stratification of Adverse Remodeling and Prognosis.JACC. Cardiovascular imaging · 2025Article
- Tissue-Based Predictors of Impaired Right Ventricular Strain in Coronary Artery Disease: A Multicenter Stress Perfusion Study.Circulation. Cardiovascular imaging · 2024Article
- Left Ventricular Papillary Muscle: Anatomy, Pathophysiology, and Multimodal Evaluation.Diagnostics (Basel, Switzerland) · 2024Review
- Numerical Study on the Impact of Central Venous Catheter Placement on Blood Flow in the Cavo-Atrial Junction.Annals of biomedical engineering · 2024Article
- Muscle Matters: CMR Tissue Characterization for Mechanistically Tailored Risk Stratification of Functional Mitral Regurgitation.Circulation. Cardiovascular imaging · 2023Article
- Abnormal Mechanics Relate to Myocardial Fibrosis and Ventricular Arrhythmias in Patients With Mitral Valve Prolapse.Circulation. Cardiovascular imaging · 2023Article
- Focus on Diagnosis and Prognosis to Guide Timing of Intervention in Valvular Heart Disease.Current cardiology reports · 2022Review
- Diagnostic value of myocardial stress detection based on feature tracking MRI in patients with acute myocardial infarction.Journal of thoracic disease · 2022Article
- Myocardial Contractile Mechanics in Ischemic Mitral Regurgitation: Multicenter Data Using Stress Perfusion Cardiovascular Magnetic Resonance.JACC. Cardiovascular imaging · 2022Article
- Mitral Plasticity: The Way to Prevent the Burden of Ischemic Mitral Regurgitation?Frontiers in cardiovascular medicine · 2021Review
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Authors and funding
26 authors at 9 institutions in 1 country.
Funding
Abstract
objectivesThe goal of this study was to test whether ischemia-mediated contractile dysfunction underlying the mitral valve affects functional mitral regurgitation (FMR) and the prognostic impact of FMR.
backgroundFMR results from left ventricular (LV) remodeling, which can stem from myocardial tissue alterations. Stress cardiac magnetic resonance can assess ischemia and infarction in the left ventricle and papillary muscles; relative impact on FMR is uncertain.
methodsVasodilator stress cardiac magnetic resonance was performed in patients with known or suspected coronary artery disease at 7 sites. Images were centrally analyzed for MR etiology/severity, mitral apparatus remodeling, and papillary ischemia.
resultsA total of 8,631 patients (mean age 60.0 ± 14.1 years; 55% male) were studied. FMR was present in 27%, among whom 16% (n = 372) had advanced (moderate or severe) FMR. Patients with ischemia localized to subpapillary regions were more likely to have advanced FMR (p = 0.003); those with ischemia localized to other areas were not (p = 0.17). Ischemic/dysfunctional subpapillary myocardium (odds ratio: 1.24/10% subpapillary myocardium; confidence interval: 1.17 to 1.31; p < 0.001) was associated with advanced FMR controlling for infarction. Among a subgroup with (n = 372) and without (n = 744) advanced FMR matched (1:2) on infarct size/distribution, patients with advanced FMR had increased adverse mitral apparatus remodeling, paralleled by greater ischemic/dysfunctional subpapillary myocardium (p < 0.001). Although posteromedial papillary ischemia was more common with advanced FMR (p = 0.006), subpapillary ischemia with dysfunction remained associated (p < 0.001), adjusting for posteromedial papillary ischemia (p = 0.074). During follow-up (median 5.1 years), 1,473 deaths occurred in the overall cohort; advanced FMR conferred increased mortality risk (hazard ratio: 1.52; 95% confidence interval: 1.25 to 1.86; p < 0.001) controlling for left ventricular ejection fraction, infarction, and ischemia.
conclusionsIschemic and dysfunctional subpapillary myocardium provides a substrate for FMR, which predicts mortality independent of key mechanistic substrates.
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