Does medical therapy, particularly beta-blockers, delay or prevent adverse left ventricular remodelling in patients with chronic primary mitral regurgitation?
This review highlights the pathophysiological mechanisms of LV remodeling in chronic primary mitral regurgitation and explores the potential role of medical therapies like beta-blockers in delaying disease progression.
Surgical repair or replacement of the mitral valve is currently the only recommended therapy for severe primary mitral regurgitation. The chronic elevation of wall stress caused by the resulting volume overload leads to structural remodelling of the muscular, vascular and extracellular matrix components of the myocardium. These changes are initially compensatory but in the long term have detrimental effects, which ultimately result in heart failure. Understanding the changes that occur in the myocardium due to volume overload at the molecular and cellular level may lead to medical interventions, which potentially could delay or prevent the adverse left ventricular remodelling associated with primary mitral regurgitation. The pathophysiological changes involved in left ventricular remodelling in response to chronic primary mitral regurgitation and the evidence for potential medical therapy, in particular beta-adrenergic blockers, are the focus of this review.
McCutcheon et al. (Mon,) studied this question.