Impact of cardiac resynchronization therapy on the severity of mitral regurgitation

Biase, Luigi Di; Auricchio, Angelo; Mohanty, Prasant; Bai, Rong; Kautzner, Josef; Pieragnoli, Paolo; Regoli, François; Sorgente, Antonio; Spinucci, Giulio; Ricciardi, Giuseppe; Michelucci, Antonio; Perrotta, Laura; Faletra, Francesco F.; Mlčochová, Hanka; Sedláček, Kamil; Canby, Robert C.; Sánchez, Javier; Horton, Rodney; Burkhardt, J. David; Moccetti, Tiziano; Padeletti, Luigi; Natale, Andrea

doi:10.1093/europace/eur047

Cited by 103 publications

(56 citation statements)

References 33 publications

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“…The bottom right panel shows systolic flow reversal (yellow arrows) in the left upper pulmonary vein, which is highly specific for severe MR LVEDD≥55 mm. Similar results were seen in the multicenter trial by Biase et al [52] (n = 794, median follow-up = 26 months). In this study, nonischemic patients (n=379), compared with the ischemic group (n=379), had a significantly higher rate of CRT responders ie, LV reverse remodeling (P >0.001).…”

Section: Cardiac Resynchronization Therapysupporting

confidence: 87%

Ischemic and Functional Mitral Regurgitation in Heart Failure: Natural History and Treatment

2014

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Functional mitral regurgitation (FMR) occurs when normal or nearly normal mitral leaflets are prevented from proper coaptation by underlying left ventricular (LV) dysfunction, mitral annular dilation, or both. FMR is associated with an adverse prognosis in nonischemic or ischemic LV dysfunction. Multiple studies have confirmed that even mild FMR portends a worse prognosis, and that the risk of FMR is independent of LV volumes and other clinical risk factors. FMR can be difficult to quantitate echocardiographically because it is load dependent and can vary considerably from exam to exam. There is a systematic tendency to underestimate FMR severity by echocardiography because the regurgitant orifice in FMR is typically elliptical, but the formula for calculating regurgitant orifice area assumes circular geometry. Treatment of FMR begins with guideline-directed medical therapy (GDMT) for LV dysfunction and heart failure, including cardiac resynchronization, if indicated. Revascularization should be considered for ischemic FMR, when indicated. Finally, mitral valve surgery should be considered in patients undergoing CABG in whom moderate or greater FMR is present, and also when severe symptomatic FMR persists despite optimal GDMT and revascularization. Percutaneous options for treatment of FMR are in development but are not currently approved in the US.

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Section: Cardiac Resynchronization Therapysupporting

confidence: 87%

Ischemic and Functional Mitral Regurgitation in Heart Failure: Natural History and Treatment

2014

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“…Of these patients, 1 underwent an additional operation with MV replacement; of the remaining 3 patients, 1 died due to HF aggravation, another 1 patient died because of non-cardiac reasons, and remained 1 patient was alive at the last follow-up. 34 In the present study, the CRT implantation rate was 41.4% (29/70). An CRT was not implanted in the remaining 41 patients (58.6%) because they did not meet the indication criteria, such as non-LBBB and atrial fibrillation, which were not considered as with acute decompensated HF had moderate/severe FMR and that only half these patients showed improvements to a lower grade of FMR after undergoing optimal medical therapy.…”

Section: Surgery For Fmrsupporting

confidence: 43%

Effect of Mitral Valve Surgery in Patients With Dilated Cardiomyopathy and Severe Functional Mitral Regurgitation

Chung

Amaki

Takashio

et al. 2018

Circ J

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Background: Surgical treatment of functional mitral regurgitation (FMR) improves ventricular remodeling in patients with dilated cardiomyopathy (DCM). However, it is unclear whether surgical treatment improves long-term outcomes. We investigated the effects of mitral valve (MV) surgery in patients with DCM and FMR. Methods and Results:Of 525 patients with DCM hospitalized due to heart failure between January 1996 and September 2014, 70 who had severe FMR despite receiving optimal medical therapy were enrolled in the study. Of these patients, 16 underwent surgery for FMR (surgery group; repair=14, replacement=2); the remaining 54 who refused or decided not to undergo surgery were classified as the medication group. There were no differences in age, sex, medication, or echocardiographic parameters between the 2 groups (P>0.05). During the mean follow-up period of 53.6±43.6 months, the occurrence of clinical outcomes (i.e., all-cause death or left ventricular assist device implantation) was 54.3%; the occurrence of clinical outcomes was lower in the surgery group (P=0.008, log-rank test). Multivariate Cox regression analysis using clinical data revealed that MV surgery (hazard ratio [HR] 0.257, 95% confidence interval [CI] 0.103-0.640; P=0.004) and diabetes mellitus (HR 2.924, 95% CI 1.243-6.876; P=0.014) were independent predictors of clinical outcomes after adjusting for age and sex.Conclusions: Surgery for severe FMR provides better long-term outcomes in patients with DCM.

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“…Moderate to severe FMR is common in heart failure (HF) patients; it occurs in approximately one-third of those with indications for cardiac resynchronization therapy (CRT) (3,4). FMR has been reported to persist in about 20% to 25% of CRT patients and, in an additional 10% to 15%, it may actually worsen after CRT (5).…”

mentioning

confidence: 99%

Correction of Mitral Regurgitation in Nonresponders to Cardiac Resynchronization Therapy by MitraClip Improves Symptoms and Promotes Reverse Remodeling

Auricchio

Schillinger

Meyer

et al. 2011

Journal of the American College of Cardiology

240

148

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Impact of cardiac resynchronization therapy on the severity of mitral regurgitation

Abstract: Mitral regurgitation improvement at 3 months predicts CRT response and MR improvement at 12-month follow-up. This finding could have implications for subsequent MR surgical therapies.

Cited by 103 publications

References 33 publications

Ischemic and Functional Mitral Regurgitation in Heart Failure: Natural History and Treatment

Ischemic and Functional Mitral Regurgitation in Heart Failure: Natural History and Treatment

Effect of Mitral Valve Surgery in Patients With Dilated Cardiomyopathy and Severe Functional Mitral Regurgitation

Correction of Mitral Regurgitation in Nonresponders to Cardiac Resynchronization Therapy by MitraClip Improves Symptoms and Promotes Reverse Remodeling

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