Key result
Cardiac resynchronization therapy induced significant reverse remodeling at 6 months (LVEF increased from 25% to 33%, p=0.00001), driving a 23% improvement from moderate/severe to mild/none FMR.
Why the study?
Functional mitral regurgitation is common in heart failure and moderate/severe FMR worsens prognosis, but the prevalence and mechanisms of FMR reduction in CRT responders across follow-up needed description.
Does cardiac resynchronization therapy reduce functional mitral regurgitation and induce reverse remodeling in heart failure patients?
Cohort (n=338)
Does cardiac resynchronization therapy reduce functional mitral regurgitation and induce reverse remodeling in heart failure patients?
Cardiac resynchronization therapy induces significant reverse remodeling and reduction in functional mitral regurgitation primarily within the first 6 months, with improvements persisting up to 24 months.
Background: Functional mitral regurgitation (FMR) is common in heart failure, and moderate/severe (M/S) FMR is associated with worse prognosis. Objective: The aim of this study was to describe the prevalence of FMR and the mechanisms involved in its reduction in responders to cardiac resynchronization therapy (CRT) at 6 months compared with 12 and 24 months. Methods: Between 2009 and 2018, 338 patients received CRT. Patients who showed NYHA functional class (FC) reduction ≥1 or left ventricular ejection fraction (LVEF) absolute increase ≥5% were considered responders. Functional mitral regurgitation was graded using a 4-point scale into none-, mild-, M- and S-FMR, and was related to echocardiographic measurements. Baseline patient characteristics were: age 64±10 years, men 71%, NYHA FC II-III 92%, left bundle branch block (LBBB) 67%, QRS ≥150 ms 75%, LV diastolic diameter (LVDD) 68±9 mm, LV systolic diameter (LVSD) 52±12 mm, and LV EF 24±7%. Results: The prevalence of FMR was 92.6%. At 6 months, 86% were responders, 23% improved from M/S-FMR to mild/none-FMR and there was strong reverse remodeling: LVDD 68±10 vs. 63±11 mm, (p=0.0001), LVSD 55±12 vs. 50±13 mm, (p=0.0006) and LVEF 25±11 vs. 33±10%, (p=0.00001). Comparing 6 with 12 months, 89.4% were responders and 8% improved M/S-FMR to mild/none-FMR. Comparing 6 with 24 months, 88% were responders and 14.6% improved M/S-FMR to mild/none-FMR. Between 6 and 12 and 6 and 24 months, there was no significant reverse remodeling. Conclusions: The prevalence of FMR was high. The highest reverse remodeling and FMR reduction was observed at 6 months, the former being the main mechanism of FMR reduction. This improvement persisted at 12 and 24 months.
No takes yet. Share an insight, caveat, or question.
Galizio et al. (2022) conducted a cohort in Heart failure with functional mitral regurgitation (n=338). Cardiac resynchronization therapy (CRT) was evaluated on Prevalence of functional mitral regurgitation and mechanisms involved in its reduction in responders to CRT at 6, 12, and 24 months. Cardiac resynchronization therapy induced significant reverse remodeling at 6 months (LVEF increased from 25% to 33%, p=0.00001), driving a 23% improvement from moderate/severe to mild/none FMR.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: