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The effects of cardiac resynchronization therapy on left ventricular and mitral valve geometry and secondary mitral regurgitation in patients with left bundle branch block
Author(s) -
Mihos Christos G.,
Santana Orlando,
Yucel Evin,
Capoulade Romain,
Upadhyay Gaurav A.,
Orencole Mary P.,
Singh Jagmeet P.,
Picard Michael H.
Publication year - 2019
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.14444
Subject(s) - cardiology , ejection fraction , medicine , cardiac resynchronization therapy , left bundle branch block , mitral regurgitation , qrs complex , heart failure , bundle branch block , mitral valve , electrocardiography
Background Secondary mitral regurgitation (MR) is common in patients with left bundle branch block (LBBB) undergoing cardiac resynchronization therapy (CRT). We aimed to define CRT effects on left ventricular (LV) and mitral valve (MV) geometry, and their correlation with MR severity. Methods Forty‐one patients with LBBB and ≥mild secondary MR underwent CRT between 2009 and 2012, and had baseline and follow‐up echocardiograms available. Repeated measure and linear regression analyses were performed to assess for changes in MV and LV geometry and MR severity, and associations with follow‐up MR grade. Results The mean age and baseline QRS duration were 65.5 ± 14.9 years and 160 ± 24 ms. At a mean follow‐up of 2.6 ± 1.8 years, there was an increase in LV ejection fraction and reductions in LV end‐systolic volume index, MR grade, and end‐systolic interpapillary muscle distance ( P < .05 for all). Linear correlations were observed between follow‐up MR grade and baseline MV tenting height ( r = .44), left atrial volume index ( r = .41), LV end‐systolic volume index ( r = .4), MV tenting area ( r = .38), LV ejection fraction ( r = −.34), and end‐systolic interpapillary muscle distance ( r = .34) ( P < .05 for all). Multiple regression analysis revealed associations between follow‐up MR grade and baseline MV tenting height ( β /mm = 0.42, P = .006) and left atrial volume index ( β /mL/m 2 = 0.4, P = .008), independent of QRS duration ( β /ms=−0.07; P = 0.6) and nonischemic cardiomyopathy ( β = −0.34, P = .02). Conclusions Cardiac resynchronization therapy in patients with LBBB and secondary MR results in LV and MV geometric reverse remodeling and decreases MR severity. Extent of baseline MV tethering is independently associated with persistent MR at follow‐up.