Contractile response and mitral regurgitation after temporary interruption of long-term cardiac resynchronization therapy

Abstract

Cessation of long-term BVP leads to a decline in LV systolic performance and an increase in functional mitral regurgitation. These results indicate a sustained benefit of long-term CRT and support the notion to maintain CRT indefinitely.

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

“…During interruption of biventricular pacing, however, both MR severity and dyssynchrony showed an acute worsening of mitral deformation indexes and parameters, reflecting global and local remodeling. Brandt et al (25) focused specifically on the hemodynamic consequences of temporary interruption of CRT in 20 patients after a median duration of biventricular pacing of 427 days and demonstrated similar results: withdrawal of CRT resulted in a decline in LV dP/dt and an increase in MR (median MR jet area from 4.1 to 5.9 mm 2 ; p ϭ 0.002). However, markers of dyssynchrony were not reported in that study.…”

Optimal use of echocardiography in cardiac resynchronisation therapy

“…The mechanism underlying the reduction in mitral regurgitation was evaluated using strain imaging. A significant mechanical delay was demonstrated between the posteromedial and anterolateral papillary muscles at baseline (106 (74) ms), which was reduced immediately after CRT implantation (12 (8) ms, p<0.001),41 42 indicating that resynchronisation of the dyssynchronous papillary muscles acutely restored valvular competency.…”

Functional Mitral Regurgitation

“…The magnitude of this effect was illustrated in a report of 20 patients with advanced heart failure who had been on CRT for a median of 427 days. 87 At 72 hours after elective temporary cessation of biventricular pacing, there were significant increases in mitral ERO area (4.8 -9.1 mm 2 ) and MR volume (7.8 -16.0 mL) and regurgitant fraction (13.8%-27.7%). These changes were associated with a significant and marked decline in the maximal rate of rise of LV systolic pressure (711-442 mm Hg/s).…”