Key result
Restrictive mitral annuloplasty significantly reduced regional end-systolic wall stress, which correlated with improved global ejection fraction (r=-0.72, p<0.01).
Why the study?
Does restrictive mitral annuloplasty improve left ventricular volume, function, and regional myocardial wall stress in patients with ischaemic cardiomyopathy and severe functional mitral regurgitation?
Observational (n=60)
Does restrictive mitral annuloplasty improve left ventricular volume, function, and regional myocardial wall stress in patients with ischaemic cardiomyopathy and severe functional mitral regurgitation?
p-value: p=<0.01
Restrictive mitral annuloplasty reduces regional systolic wall stress and improves ejection performance of non-infarcted myocardium in patients with functional mitral regurgitation and ischaemic cardiomyopathy.
May reduce wall stress and improve EF after restrictive annuloplasty in ischaemic MR; hypothesis-generating and requires randomized confirmation.
OBJECTIVES: The objective of this study was to assess changes in left ventricular (LV) volume, function and regional myocardial wall stress in non-infarcted segments following restrictive mitral annuloplasty (RMA) in patients with ischaemic cardiomyopathy (ICM) and severe functional mitral regurgitation (MR). PATIENTS AND METHODS: Twenty-two patients with ICM (ejection fraction <35%) and severe MR were investigated before and 3 months after RMA using cine-angiographic multidetector row computed tomography (cine-MDCT). For comparative purposes, 38 normal subjects were also studied. Cine-MDCT LV images were reconstructed in a cardiac cycle and regional circumferential wall stress (end-systolic stress (ESS)) was evaluated from the LV end-systolic image using Janz's method. The ESS was determined in six basal and six mid-LV segments of the ventricle based on AHA/ASE criteria. Five apical infarcted segments were not analysed. Mean circumferential fibre shortening (CFS) in both basal and mid-LV regions was determined as a parameter of regional systolic performance. RESULTS: Left ventricular end-diastolic volume (index) (LVEDVI) and left ventricular end-systolic volume (index) (LVESVI) decreased significantly and left ventricular ejection fraction (LVEF) increased after surgery. Neither end-systolic nor end-diastolic sphericity index changed significantly after surgery. Regional ESS significantly decreased in both basal and mid-LV regions after surgery. There was a significant inverse correlation between the change in average value of regional ESS and magnitude of increase in mean CFS of the mid-LV region (r=-0.67, p=0.0018). Postoperative reduction in ESS in the mid-LV region was also correlated with improvement in global EF (r=-0.72, p<0.01). CONCLUSION: The present cine-MDCT may be useful for assessing regional myocardial stress in patients with ICM. We found that RMA could reduce both end-diastolic and end-systolic volume leading to reduction in regional systolic wall stress, which resulted in improved ejection performance of non-infarcted myocardium in patients with functional MR and ICM.
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Shudo et al. (2010) conducted an observational in Ischaemic cardiomyopathy with severe functional mitral regurgitation (n=60). Restrictive mitral annuloplasty vs. Baseline (before surgery) was evaluated on Changes in left ventricular volume, function and regional myocardial wall stress (end-systolic stress) (p=<0.01). Restrictive mitral annuloplasty significantly reduced regional end-systolic wall stress, which correlated with improved global ejection fraction (r=-0.72, p<0.01).
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