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Impact of cardiac resynchronization therapy on mitral valve apparatus geometry and clinical outcomes in patients with secondary mitral regurgitation
Author(s) -
Mihos Christos G.,
Yucel Evin,
Capoulade Romain,
Orencole Mary P.,
Upadhyay Gaurav A.,
Santana Orlando,
Singh Jagmeet P.,
Picard Michael H.
Publication year - 2017
Publication title -
echocardiography
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.404
H-Index - 62
eISSN - 1540-8175
pISSN - 0742-2822
DOI - 10.1111/echo.13690
Subject(s) - medicine , cardiology , ejection fraction , cardiac resynchronization therapy , mitral regurgitation , heart failure , cardiomyopathy , dilated cardiomyopathy , functional mitral regurgitation , mitral valve , mitral valve repair
Background Cardiac resynchronization therapy (CRT) may improve secondary mitral regurgitation (MR) in patients with cardiomyopathy. The effects on mitral valve (MV) and left ventricular (LV) geometry, however, have not been clearly defined. Methods Between 2009 and 2012, 229 CRT implants were performed at a single academic center. Seventy‐one had ≥mild MR at baseline and serial echocardiography, without subsequent MV intervention. The pre‐CRT and follow‐up echocardiograms were retrospectively reviewed for (1) MV and LV geometry measurements; (2) MR grade; and (3) LV remodeling indices. Results The mean age was 67 ± 15 years, and the cardiomyopathy was ischemic in 37 (52%). At a mean follow‐up of 4.0 ± 1.9 years, there were significant improvements in LV ejection fraction and size, MR grade, MV tenting area and anterior leaflet tethering angle, and end‐systolic interpapillary muscle distance (IPMD), and reductions in moderate‐to‐severe or severe MR (27% vs 15%; P = .04) and New York Heart Association functional class III/IV symptoms (83% vs 41%; P < .001). Multivariable analysis revealed the pre‐CRT MV tenting height (OR 1.25, 95% CI 1.01–1.56; P = .04) and end‐systolic IPMD (OR 1.14, 95% CI 0.99–1.32; P = .08) as independently associated with moderate or greater MR at follow‐up. Finally, at 5 years post‐CRT implantation, the estimated survival and freedom from LV assist device or cardiac transplantation was 61%. Conclusions CRT results in favorable effects on MV and LV geometry and decreases the prevalence of moderate‐to‐severe or severe MR and heart failure symptoms. The pre‐CRT MV tenting height and IPMD are independently associated with persistent MR at follow‐up.