The Role of Cardiac Resynchronization Therapy for the Management of Functional Mitral Regurgitation

Russo, Eleonora; Russo, Giulio; Cassese, Mauro; Braccio, Maurizio; Carella, Massimo; Compagnucci, Paolo; Russo, Antonio Dello; Casella, Michela

doi:10.3390/cells11152407

Cited by 8 publications

(3 citation statements)

References 69 publications

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“… 10 , 11 Although the long-term decrease in FMR due to CRT is secondary to left ventricular remodelling, the acute effect of CRT on FMR is driven by the mechanism correcting papillary muscle dyssynchrony. 12 In patients with HF and left bundle branch abnormality, post-CRT changes in interpapillary muscle activation time delay, as measured by echocardiographic strain imaging, have been reported to correlate significantly with immediate improvement in MR. 13 Additionally, speckle-tracking analysis conducted both at baseline and after CRT implantation could be valuable in predicting the acute effect of CRT on FMR.…”

Section: Discussionmentioning

confidence: 99%

Successful intervention for decompensated heart failure with complicated pathophysiologies with complex interdependence: a case report

Muraishi,

Noguchi,

Makihara

et al. 2024

European Heart Journal - Case Reports

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Background There is limited evidence regarding the optimal strategy for treating patients with acute decompensated heart failure complicated by severe left ventricular dysfunction, functional mitral regurgitation (FMR), and atrial septal defect that cannot be controlled despite optimal medical treatment. Case summary A 72-year-old man with non-ischemic cardiomyopathy presented with acute heart failure and recurrent atrial fibrillation. An electrocardiogram after electrical cardioversion revealed left bundle block with QRS duration of 152 ms. Transthoracic echocardiography revealed severe left ventricular dysfunction, severe FMR, and a left-to-right shunt through an iatrogenic atrial septal defect (IASD). Despite initial optimal medical therapy for heart failure, the patient's condition was not completely controlled. After a discussion among the heart team, we performed cardiac resynchronization therapy (CRT) as the next strategy. Two weeks after CRT device implantation, heart failure was controlled, with improvement in cardiac function and FMR. The left-to-right shunts through the IASD also improved. Discussion When treating decompensated heart failure with complicated pathophysiologies, it is crucial to prioritize the predominant pathophysiological factor and engage in thorough discussions with the heart team regarding the most appropriate intervention.

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Section: Discussionmentioning

confidence: 99%

Successful intervention for decompensated heart failure with complicated pathophysiologies with complex interdependence: a case report

Muraishi,

Noguchi,

Makihara

et al. 2024

European Heart Journal - Case Reports

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“…Another important connector between CRT and LA function might be mitral regurgitation, due to its impact on LA size, shape, and function. It is known that CRT might become useful in managing functional mitral regurgitation due to the fact that cardiac dyssynchrony aggravates the severity of regurgitation [ 99 ]. Further studies should assess whether reducing mitral regurgitant volume and fraction by CRT might lower the burden on LA volumes and functioning and possibly improve LV diastolic dysfunction.…”

Section: Future Perspectivesmentioning

confidence: 99%

Cardiac Resynchronization Therapy and Left Atrial Remodeling: A Novel Insight?

et al. 2023

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Cardiac resynchronization therapy (CRT) restores ventricular dyssynchrony, improving left ventricle (LV) systolic function, symptoms, and outcome in patients with heart failure, systolic dysfunction, and prolonged QRS interval. The left atrium (LA) plays tremendous roles in maintaining cardiac function, being often inflicted in various cardiovascular diseases. LA remodeling implies structural—dilation, functional—altered phasic functions, and strain and electrical—atrial fibrillation remodeling. Until now, several important studies have approached the relationship between LA and CRT. LA volumes can predict responsiveness to CRT, being also associated with improved outcome in these patients. LA function and strain parameters have been shown to improve after CRT, especially in those who were positive responders to it. Further studies still need to be conducted to comprehensively characterize the impact of CRT on LA phasic function and strain, and, also, in conjunction with its impact on functional mitral regurgitation and LV diastolic dysfunction. The aim of this review was to provide an overview of current available data regarding the relation between CRT and LA remodeling.

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“…This phenomenon is typical for a severe enlargement of LV both in ischemic and non-ischemic HF, as well as in long-standing AF, which causes a dilatation of the left atrium and mitral annulus leading to fMR without an enlargement of LV and systolic dysfunction [ 80 ]. The approach to the treatment of severe fMR should concentrate primarily on HF pharmacotherapy and biventricular pacing with CRT [ 81 ], which have both been shown to limit the extent of fMR and improve symptoms. The use of sacubitril/valsartan in patients with heart failure and fMR was linked to a reduced effective regurgitant orifice area in comparison to valsartan alone [ 82 ].…”

Section: Functional Mitral Valve Insufficiency: a Common Pitfall In T...mentioning

confidence: 99%

Heart Failure with Improved Ejection Fraction: Insight into the Variable Nature of Left Ventricular Systolic Function

Wybraniec

Orszulak

Męcka

et al. 2022

IJERPH

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The progress of contemporary cardiovascular therapy has led to improved survival in patients with myocardial disease. However, the development of heart failure (HF) represents a common clinical challenge, regardless of the underlying myocardial pathology, due to the severely impaired quality of life and increased mortality comparable with malignant neoplasms. Left ventricular ejection fraction (LVEF) is the main index of systolic function and a key predictor of mortality among HF patients, hence its improvement represents the main indicator of response to instituted therapy. The introduction of complex pharmacotherapy for HF, increased availability of cardiac-implantable electronic devices and advances in the management of secondary causes of HF, including arrhythmia-induced cardiomyopathy, have led to significant increase in the proportion of patients with prominent improvement or even normalization of LVEF, paving the way for the identification of a new subgroup of HF with an improved ejection fraction (HFimpEF). Accumulating data has indicated that these patients share far better long-term prognoses than patients with stable or worsening LVEF. Due to diverse HF aetiology, the prevalence of HFimpEF ranges from roughly 10 to 40%, while the search for reliable predictors and genetic associations corresponding with this clinical presentation is under way. As contemporary guidelines focus mainly on the management of HF patients with clearly defined LVEF, the present review aimed to characterize the definition, epidemiology, predictors, clinical significance and principles of therapy of patients with HFimpEF.

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The Role of Cardiac Resynchronization Therapy for the Management of Functional Mitral Regurgitation

Cited by 8 publications

References 69 publications

Successful intervention for decompensated heart failure with complicated pathophysiologies with complex interdependence: a case report

Successful intervention for decompensated heart failure with complicated pathophysiologies with complex interdependence: a case report

Cardiac Resynchronization Therapy and Left Atrial Remodeling: A Novel Insight?

Heart Failure with Improved Ejection Fraction: Insight into the Variable Nature of Left Ventricular Systolic Function

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