Key result
Baseline important FMR linked to a lack of reverse remodeling following CRT.
Why the study?
Although CRT reduces functional mitral regurgitation, FMR has also been associated with a lack of clinical response to CRT, leaving its influence on reverse remodelling uncertain.
Does baseline functional mitral regurgitation severity influence reverse remodelling after cardiac resynchronization therapy in patients with dilated cardiomyopathy?
Cohort (n=20)
Does baseline functional mitral regurgitation severity influence reverse remodelling after cardiac resynchronization therapy in patients with dilated cardiomyopathy?
In patients with dilated cardiomyopathy undergoing CRT, significant baseline functional mitral regurgitation (ROA >= 0.20 cm2) is associated with a lack of echocardiographic reverse remodeling.
May identify CRT non-responders for reverse remodelling; hypothesis-generating for targeted MR strategies in dilated cardiomyopathy.
AIMS: Cardiac resynchronization therapy (CRT) reduces the degree of functional mitral regurgitation (FMR). However, FMR has also been associated with a lack of clinical response to CRT. We undertook this study to determine whether the presence of FMR influences the reverse remodelling induced by CRT. METHODS AND RESULTS: We used Doppler echocardiography to assess 20 patients with dilated cardiomyopathy before and 6 months after undergoing CRT. We evaluated the effect of reverse remodelling (reduction > or = 10% in end-systolic volume) according to the presence or absence of important FMR, defined as a regurgitant orifice area (ROA) of > or = 0.20 cm(2). Of the 20 patients (mean age, 64.7 +/- 8.2 years, eight women), 9 had marked FMR (ROA 0.40 +/- 0.12 cm(2)), 6 mild FMR (ROA 0.15 +/- 0.02 cm(2)), and 5 had trivial or no FMR. CRT reduced the presence of mitral regurgitation by 33.3% and induced reverse remodelling in 60% of the patients. A ROA > or = 0.20 cm(2) was associated with a lack of reverse remodelling, despite presenting similar baseline characteristics and a reduction in asynchrony to the other patients. Reverse remodelling was produced in all the other patients, with a significant reduction in end-systolic volume (41.7 +/- 21%; P = 0.003), accompanied by improvement in the ejection fraction (P = 0.003) and myocardial performance index (P = 0.027). CONCLUSION: CRT improved FMR, although the baseline presence of important mitral regurgitation, with a ROA > or = 0.20 cm(2), in patients undergoing CRT was associated with a lack of response in reverse remodelling.
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Cabrera‐Bueno et al. (2007) conducted a cohort in Dilated cardiomyopathy (n=20). Important functional mitral regurgitation (ROA ≥ 0.20 cm²) vs. Mild, trivial, or no functional mitral regurgitation was evaluated on Reverse remodelling (reduction ≥ 10% in end-systolic volume). Baseline important functional mitral regurgitation (ROA ≥ 0.20 cm²) in patients undergoing cardiac resynchronization therapy was associated with a lack of reverse remodelling.
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