Effects of cardiac resynchronization therapy on the mechanisms underlying functional mitral regurgitation in congestive heart failure

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Congestive heart failure with functional mitral regurgitation (n=30). Intervention: Cardiac resynchronization therapy vs. Baseline (before implant). Primary outcome: Reduction of functional mitral regurgitation (JA/LAA reduction) (r2=0.697, p=<0.01).

Q: What does this research mean for the field?

Cardiac resynchronization therapy reduces functional mitral regurgitation independently of left ventricular reverse remodeling, primarily through the reduction of left ventricular mid-segmental asynchrony. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

M PORCIANI; Roberto Macioce; Gabriele Demarchi; Marco Chiostri; Nicola Musilli; Francesco Cappelli; Alessio Lilli; Giulia Ricciardi; Luigi Padeletti

doi:10.1016/j.euje.2005.03.008

May 5, 2005European Journal of EchocardiographyOpen Access

Effects of cardiac resynchronization therapy on the mechanisms underlying functional mitral regurgitation in congestive heart failure

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Key result

Cardiac resynchronization therapy reduced functional mitral regurgitation irrespective of LV remodeling reversal, correlating with LV mid-segmental asynchrony reduction (r2=0.697, P<0.01).

Why the study?

The effects of changes in left ventricular synchronicity indexes induced by cardiac resynchronization therapy on functional mitral regurgitation severity had not been investigated.

Does cardiac resynchronization therapy reduce functional mitral regurgitation severity in patients with heart failure and QRS>130 ms?

Study Design

Type

Observational (n=30)

Structured PICO

Does cardiac resynchronization therapy reduce functional mitral regurgitation severity in patients with heart failure and QRS>130 ms?

P

Population

30 patients with heart failure and QRS>130 ms undergoing cardiac resynchronization therapy, evaluated before and 6 months after implant.

E

Exposure

Cardiac resynchronization therapy (CRT)

C

Comparator

Baseline (before implant)

O

Outcome

Functional mitral regurgitation (FMR) severity (mitral jet regurgitation/left atrial area ratio [JA/LAA]) and LV asynchrony indexes at 6 monthssurrogate

Main Result

Effect estimate: r2=0.697

p-value: p=<0.01

Implication

Cardiac resynchronization therapy reduces functional mitral regurgitation severity in heart failure patients by reducing LV asynchrony, independent of LV reverse remodeling.

Abstract

AIMS: Functional mitral regurgitation (FMR) improvement induced by cardiac resynchronization therapy (CRT) has been related to left ventricular (LV) remodeling reversal and contractility enhancement. The effects induced by the changes of LV synchronicity indexes on FMR severity have not been investigated. METHODS AND RESULTS: In 30 patients with CRT for heart failure (HF) and QRS>130 ms, LV function parameters, FMR severity as mitral jet regurgitation/left atrial area ratio (JA/LAA) and standard deviation (SD) of the time to the systolic peak velocity at 6-basal and mid-LV segments as asynchrony indexes were evaluated (echo/tissue Doppler) before and 6 months after implant. At follow-up, 15 patients resulted responders to LV reverse remodeling with > or =15% end-systolic volume (ESV) and LV systolic function improvement. Improvement of FMR with > or =15% JA/LAA reduction was observed in 19 patients, 7 were nonresponders to LV reverse remodeling. In patients with > or =15% JA/LAA reduction a significant decrease of LV asynchrony indexes was observed as compared to patients without > or =15% JA/LAA reduction in whom LV asynchrony indexes were increased. Reduction of LV mid-segmental asynchrony was the variable most strongly related to JA/LAA reduction (r(2)=0.697, P<0.01), with good agreement between observed and predicted values (only 1 patient outside the mean+/-2SD). CONCLUSION: These data reveal that CRT can reduce FMR irrespective to LV remodeling reversal; this effect is related to LV asynchrony reduction and further support CRT employment in patients with HF and FMR.

Discussion

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Cite This Study

PORCIANI et al. (2005) conducted an observational in Congestive heart failure with functional mitral regurgitation (n=30). Cardiac resynchronization therapy vs. Baseline (before implant) was evaluated on Reduction of functional mitral regurgitation (JA/LAA reduction) (r2=0.697, p=<0.01). Cardiac resynchronization therapy reduced functional mitral regurgitation irrespective of LV remodeling reversal, correlating with LV mid-segmental asynchrony reduction (r2=0.697, P<0.01).

synapsesocial.com/papers/6aa7bac2871ca30df5b18012 https://doi.org/10.1016/j.euje.2005.03.008