Computational protocol: Chronic ischemic mitral regurgitation and papillary muscle infarction detected by late gadolinium-enhanced cardiac magnetic resonance imaging in patients with ST-segment elevation myocardial infarction

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Protocol publication

[…] Images were stored and sent to an independent cardiac MRI core laboratory (Image Analysis Center, VU University Medical Center, Amsterdam, The Netherlands) for assessment by fully blinded operators. Additional assessment of PMI and mitral valve geometry was performed using an open-source software package (OsiriX Imaging Software).Summation of the volumes per slice of areas of hyperenhancement was outlined, allowing calculation of total infarct size (% LV myocardium). PMI was evaluated by LGE cardiac MRI images. Cine images of the same location were used as a side-by-side reference for localizing the PM within the blood pool during interpretation of contrast-enhanced images. PMI was considered present if any papillary hyperenhancement was present on LGE images. PMI was further categorized by location (anterolateral PMI and/or posteromedian PMI) and extent (partial (≤50 % hyperenhanced papillary myocardium) or complete (>50 % hyperenhanced papillary myocardium) on LGE short-axis images (Fig. ) [].Fig. 1 Left atrial volume was calculated using the summation of slices method multiplied by slice thickness. Left ventricular end-diastolic diameter (LVEDD) and left ventricular end-systolic diameter (LVESD) were measured in the short-axis view at mid-LV level. Additionally, the systolic sphericity index (SSI) (ratio of LV width to length) was measured in the four-chamber view at end-systole. Interpapillary muscle distance (IPMD) was measured in the short-axis view at end-systole. On the stack of short-axis cines, the endocardial and epicardial borders were outlined in end-systolic and end-diastolic images. Left ventricular end-diastolic volume (LVEDV) and left ventricular end-systolic volume (LVESV) were calculated using the summation of slice method multiplied by slice thickness. LVEF was calculated as LVEF = 100 % × (LVEDV-LVESV)/LVEDV. Regional LV contractile function was graded with the wall motion score index (WMSI) using a 17-segment, 5-point scoring system (1 = normal contraction; 2 = hypokinesia; 3 = akinesia; 4 = dyskinesia; 5 = aneurysmatic).Mitral annular diameter, tethering height (distance between the leaflet coaptation point and the mitral annular plane), tethering area (area enclosed between the annular plane and the mitral leaflets) posterior tethering angle, and anterior tethering angle were measured in the 3-chamber view (mid-systolic) (Fig. ) [].Fig. 2 [...] Continuous variables were expressed as mean ± SD. Categorical variables were expressed as percentages. Comparisons between groups were performed using Pearson’s Chi-square test or Fisher`s exact test as appropriate for categorical variables and the independent samples t test or Mann–Whitney U test as appropriate for continuous variables. Univariate variables with P <0.10 were included in the multivariate analysis. Age and gender were forced in all multivariate models. Multivariate logistic regression analyses by means of a forward stepwise algorithm (cut-off for entry and removal set at a significance level of 0.05) were performed to identify independent predictors of PMI and CIMR. Odds ratios were reported with 95 % confidence intervals (CI). Goodness-of-fit of the final logistic regression models was assessed with the Hosmer–Lemeshow statistic.All calculations were performed using commercially available statistical packages (IBM SPSS Statistics 21.0; IBM Corporation, Chicago, IL, USA and Stats Direct 2.8.0; StatsDirect Ltd, Chesire, UK). Statistically significant differences were defined as P < 0.05. […]

Pipeline specifications

Software tools OsiriX, SPSS
Applications Miscellaneous, Magnetic resonance imaging
Organisms Homo sapiens
Diseases Mitral Valve Insufficiency, Myocardial Infarction
Chemicals Gadolinium