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This editorial refers to ‘Impact of reduction in early- and late-systolic functional mitral regurgitation on reverse remodelling after cardiac resynchronization therapy, by Y. Liang et al. , doi:10.1093/eurheartj/ehq134 Functional mitral regurgitation (MR) is a common finding in patients with global left ventricular (LV) dilatation and dysfunction.1 In these patients, the mitral leaflets are structurally normal and leaflet coaptation failure results from an imbalance between valve closing forces and valve tethering forces.2,3 Impaired LV contractility, global LV dyssynchrony, and reduced mitral annulus systolic contraction lead to a significant reduction in valve closing forces. In turn, valve tethering forces are increased due to mitral annulus dilatation, LV remodelling, and papillary muscle displacement.4 Furthermore, MR per se induces additional adverse ventricular remodelling through volume overload, and plays an important role in the progression of the cardiomyopathy.The presence of significant functional MR also has important prognostic implications,5,6 and is associated with a relatively high morbidity and mortality. Surgery is the preferred therapeutic option, but several recent studies demonstrated that cardiac resynchronization therapy (CRT) might also be able to reduce functional MR.7–10 Reduction of MR following CRT was shown to be related to various issues. First, the reduction in LV dyssynchrony and the improvement in LV contraction immediately after CRT can significantly increase valve closing forces.7,10 Secondly, LV reverse remodelling and changes in mitral apparatus geometry can further reduce MR by reducing … *Corresponding author. Tel: +31 71 5262020, Fax: +31 71 5266809, Email: j.j.bax{at}lumc.nl

Changes in functional mitral regurgitation after cardiac resynchronization therapy