Journal Article

Repercussion of functional mitral regurgitation on reverse remodelling in cardiac resynchronization therapy

Fernando Cabrera-Bueno, José Manuel García-Pinilla, José Peña-Hernández, Manuel Jiménez-Navarro, Juan José Gómez-Doblas, Alberto Barrera-Cordero, Javier Alzueta-Rodríguez and Eduardo de Teresa-Galván

in EP Europace

Published on behalf of European Heart Rhythm Association of the European Society of Cardiology (ESC)

Volume 9, issue 9, pages 757-761
Published in print September 2007 | ISSN: 1099-5129
Published online June 2007 | e-ISSN: 1532-2092 | DOI: http://dx.doi.org/10.1093/europace/eum122
Repercussion of functional mitral regurgitation on reverse remodelling in cardiac resynchronization therapy

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Aims Cardiac resynchronization therapy (CRT) reduces the degree of functional mitral regurgitation (FMR). However, FMR has also been associated with a lack of clinical response to CRT. We undertook this study to determine whether the presence of FMR influences the reverse remodelling induced by CRT.

Methods and results We used Doppler echocardiography to assess 20 patients with dilated cardiomyopathy before and 6 months after undergoing CRT. We evaluated the effect of reverse remodelling (reduction ≥ 10% in end-systolic volume) according to the presence or absence of important FMR, defined as a regurgitant orifice area (ROA) of ≥ 0.20 cm2. Of the 20 patients (mean age, 64.7 ± 8.2 years, eight women), 9 had marked FMR (ROA 0.40 ± 0.12 cm2), 6 mild FMR (ROA 0.15 ± 0.02 cm2), and 5 had trivial or no FMR. CRT reduced the presence of mitral regurgitation by 33.3% and induced reverse remodelling in 60% of the patients. A ROA ≥ 0.20 cm2 was associated with a lack of reverse remodelling, despite presenting similar baseline characteristics and a reduction in asynchrony to the other patients. Reverse remodelling was produced in all the other patients, with a significant reduction in end-systolic volume (41.7 ± 21%; P = 0.003), accompanied by improvement in the ejection fraction (P = 0.003) and myocardial performance index (P = 0.027).

Conclusion CRT improved FMR, although the baseline presence of important mitral regurgitation, with a ROA ≥ 0.20 cm2, in patients undergoing CRT was associated with a lack of response in reverse remodelling.

Keywords: Cardiac resynchronization; Reverse remodelling; Mitral regurgitation

Journal Article.  3297 words. 

Subjects: Cardiovascular Medicine

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