Acute Effects of Initiation and Withdrawal of Cardiac Resynchronization Therapy on Papillary Muscle Dyssynchrony and Mitral Regurgitation

Ypenburg, Claudia; Lancellotti, Patrizio; Tops, Laurens F.; Bleeker, Gabe B.; Holman, Eduard R.; Piérard, Luc; Schalij, Martin J.; Bax, Jeroen J.

doi:10.1016/j.jacc.2007.08.019

Cited by 171 publications

(104 citation statements)

References 35 publications

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“…One-year mortality was not reported, although the small study size did not allow for meaningful assessment of survival. Data are not provided on the use of evidence-based medical therapies in either the study by Chan et al 22 or the study by Fattouch et al, 21 including on the use of cardiac resynchronization therapy when appropriate, an intervention proven to reduce the severity of ischemic MR. [23][24][25] Firm conclusions regarding the efficacy and safety of MVRp at time of CABG surgery in patients with moderate ischemic MR cannot be drawn from these studies. Nevertheless, and despite the several important limitations and concerns noted, both groups of investigators are to be congratulated for conducting these RCTs.…”

Section: Article See P 2502mentioning

confidence: 99%

Randomized Trials in Moderate Ischemic Mitral Regurgitation

O’Gara

2012

Circulation

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Section: Article See P 2502mentioning

confidence: 99%

Randomized Trials in Moderate Ischemic Mitral Regurgitation

O’Gara

2012

Circulation

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“…51 The beneficial effect of CRT on sec ondary MR occurs through the reversal of adverse LV remodelling, improved LV systolic function, increased closing force (indicated by a change in EROA, which was directly related to the increase in LV dP/dt) and improved coordinated timing of mechanical activation of the papillary muscles. 52,53 However, these bene fits are reversible, and studies have demonstrated that CRT withdrawal after 6 months of implantation acutely results in MR recurrence. 54,55 In addition, owing to the smaller benefits in LV remodelling derived from CRT in patients with ischaemic cardiomyopathy, the regression of MR is subsequently less in this subset of patients.…”

Section: Cardiac Resynchronization Therapymentioning

confidence: 99%

Therapeutic decision-making for patients with fluctuating mitral regurgitation

2015

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| Mitral regurgitation (MR) is a common, progressive, and difficult-to-manage disease. MR is dynamic in nature, with physiological fluctuations occurring in response to various stimuli such as exercise and ischaemia, which can precipitate the development of symptoms and subsequent cardiac events. In both chronic primary and secondary MR, the dynamic behaviour of MR can be reliably examined during stress echocardiography. Dynamic fluctuation of MR can also have prognostic value; patients with a marked increase in regurgitant volume or who exhibit increased systolic pulmonary artery pressure during exercise have lower symptom-free survival than those who do not experience significant changes in MR and systolic pulmonary artery pressure during exercise. Identifying patients who have dynamic MR, and understanding the mechanisms underlying the condition, can potentially influence revascularization strategies (such as the surgical restoration of coronary blood flow) and interventional treatment (including cardiac resynchronization therapy and new approaches targeted to the mitral valve).

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“…CRT reduces the amount of FMR in patients with LV systolic failure (9)(10)(11)(12)(13)(14)(33)(34)(35)(36)(37)(38). Effects of CRT on FMR are acute and longterm, due to the reverse remodeling of the LV.…”

Section: Cardiac Resynchronization Therapy and Functional Mitral Regumentioning

confidence: 99%

“…CRT reduces the amount of FMR in patients with left ventricular (LV) systolic failure (9)(10)(11)(12)(13)(14). Studies have shown that the severity of FMR was correlated with the papillary muscle dyssynchrony (PMD) (15)(16)(17)(18).…”

Section: Introductionmentioning

confidence: 99%

Functional mitral regurgitation and papillary muscle dyssynchrony in patients with left ventricular systolic dysfunction

Güler¹,

Dündar²,

Tigen³

2011

Anadolu Kardiyol Derg

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ÖZETSistolik fonksiyonları bozuk olan genişlemiş bir kalpte, mitral kapakta yapısal bir bozukluk olmasa bile fonksiyonel olarak yetersizlik meydana gelebilir. Fonksiyonel mitral yetersizliğinin gelişmesinde birçok mekanizma beraber rol alır. Bunlar, mitral kapağı kalbin apeksine doğru çeken kuvvetlerdeki artış, sistol sırasında kapağı kapayıcı kuvvetlerdeki azalma ve mekanik ve elektriksel dissenkronidir. Papiller adele dissenkronisi de fonksiyonel mitral yetersizliğine katkıda bulunan nedenlerden biridir. Sistolik kalp yetersizliği olan hastalarda -bazı durumlarda yanıt alına-mayabilirse de-kardiyak resenkronizasyon tedavisi ile fonksiyonel mitral yetersizliğinin gerilediği bilinir. Papiller adele dissenkronisi fonksiyonel mitral yetersizliğinin gerilemesi bakımından kardiyak resenkronizasyon tedavisine yanıtı tahmin edebilir ve koroner revaskülarizasyon, mitral onarım veya kardiyak resenkronizasyon tedavisi gibi farklı tedavilerden hangisinin seçileceği ya da beraber uygulanacağı konusunda yol göste-rici olabilir. Bu derlemede fonksiyonel mitral yetersizliğinin mekanizmaları, papiller adele dissenkronisi ve fonksiyonel mitral yetersizliği arasın-daki ilişki, papiller adele dissenkronisi ile kardiyak resenkronizasyon tedavisi sonrası fonksiyonel mitral yetersizliğindeki gerileme arasındaki ilişki incelenmiştir. ABSTRACTIn a dilated heart with impaired systolic functions, functional mitral regurgitation could be seen even in the presence of structurally normal mitral apparatus. A number of mechanisms play role in the development of functional mitral regurgitation. These are increased mitral tethering forces, reduction in closing forces and mechanical and electrical dyssynchrony. Papillary muscle dyssynchrony has also been shown to be related with functional mitral regurgitation. Cardiac resynchronization therapy is known to reduce the amount of functional mitral regurgitation in patients with left ventricular systolic failure although some may not respond to treatment with cardiac resynchronization therapy. Papillary muscle dyssynchrony may predict the response of cardiac resynchronization therapy on the regression of functional mitral regurgitation and may suggest the suitable therapeutic options, such as cardiac resynchronization therapy, mitral valve repair, coronary revascularization separately or in combination. In this review, the mechanisms of functional mitral regurgitation, papillary muscle dyssynchrony and its relationship with functional mitral regurgitation and the relationship of papillary muscle dyssynchrony with the improvement of functional mitral regurgitation after cardiac resynchronization therapy are focused. (Anadolu Kardiyol Derg 2011; 11: 450-5)

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Acute Effects of Initiation and Withdrawal of Cardiac Resynchronization Therapy on Papillary Muscle Dyssynchrony and Mitral Regurgitation

Abstract: Cardiac resynchronization therapy can acutely reduce MR in patients with dyssynchrony involving the papillary muscles; interruption of CRT at 6 months' follow-up, however, resulted in acute loss of resynchronization with recurrence of MR.

Cited by 171 publications

References 35 publications

Randomized Trials in Moderate Ischemic Mitral Regurgitation

Randomized Trials in Moderate Ischemic Mitral Regurgitation

Therapeutic decision-making for patients with fluctuating mitral regurgitation

Functional mitral regurgitation and papillary muscle dyssynchrony in patients with left ventricular systolic dysfunction

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