Cor Vasa 2017, 59(2):e142-e148 | DOI: 10.1016/j.crvasa.2016.06.002

Impact of papillary muscles on ventricular function measurements in 3T cardiac magnetic resonance

Silvio Quick^*, Nadine Waessnig, Philip Sommer, Felix M. Heidrich, Christian Pfluecke, Karim Ibrahim, Ruth Strasser, Uwe Speiser, Stefan Wiedemann

Technische Universität Dresden, University Hospital, Heart Center, Department of Internal Medicine and Cardiology, Dresden, Germany

Background: Prior studies revealed, that left and right ventricular (LV, RV) volume, mass and function differ significantly, depending on trabeculae papillary and papillary muscles (TPM) have been included or excluded in LV and RV calculations.

Methods: A cohort of 101 patients underwent CMR. It constituted of 26 patients without pathological findings in CMR (reference group), patients with ischemic cardiomyopathy (ICM), dilated cardiomyopathy (DCM) and patients with left ventricular hypertrophy (25 per group). Left and right ventricular parameters were determined using previously established methods: Method 1 inclusion and method 2 exclusion of TPM in cavity volume.

Results: Compared with inclusion of TPM, exclusion of TPM in the LV and RV cavity volume resulted in significantly lower end-diastolic and end-systolic volume (EDV, ESV) and myocardial mass, and larger stroke volume and ejection fraction (SV, EF) (p = 0.001). The fraction of the TPM on the LV and RV mass was highest in DCM (18.4 ± 3.8%,) and in CM (17.8 ± 3.2%) compared to the reference group (15.2 ± 2.5%, both p < 0.05), which resulted in a significant larger difference between the two methods (method 1 - method 2) in calculating ESV, EDV, SV, EF and myocardial mass among DCM and ICM patients vs. reference group.

Conclusion: Global CMR LV parameters are significantly affected by whether TPM are considered as part of the LV blood pool or as part of LV mass. Therefore, a consistent method of LV cavity delineation may be crucial during longitudinal follow-up to avoid misinterpretation and erroneous clinical decision-making.

Keywords: Cardiac MRI; Dilated cardiomyopathy; Ejection fraction; Hypertrophy; Ischemic cardiomyopathy; Papillary muscles; Trabeculae

Received: May 8, 2016; Revised: June 29, 2016; Accepted: June 29, 2016; Published: April 1, 2017  Show citation