Acute effects of cardiac resynchronization therapy on functional mitral regurgitation in advanced systolic heart failure

Breithardt, Ole A.; Sinha, Anil M.; Schwammenthal, Ehud; Bidaoui, Nadim; Markus, Kai U.; Franke, Andreas; Stellbrink, Christoph

doi:10.1016/s0735-1097(02)02937-6

Cited by 462 publications

(292 citation statements)

References 33 publications

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“…[1][2][3] CRT improves left ventricular systolic and diastolic function 4 and clinical status 5 and reduces functional mitral regurgitation (MR). 6 Whether CRT significantly affects exercise-induced changes in MR has never been investigated. This study examined the effects of CRT on MR and assessed the determinants of exercise-induced changes in MR under biventricular pacing.…”

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confidence: 99%

Effect of cardiac resynchronization therapy on functional mitral regurgitation in heart failure

Lancellotti¹,

Mélon²,

Sakalihasan

et al. 2004

The American Journal of Cardiology

102

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C ardiac resynchronization therapy (CRT) with biventricular pacing has emerged as a new approach for treating patients with heart failure and significant ventricular conduction delay and/or dyssynchrony. 1-3 CRT improves left ventricular systolic and diastolic function 4 and clinical status 5 and reduces functional mitral regurgitation (MR). 6 Whether CRT significantly affects exercise-induced changes in MR has never been investigated. This study examined the effects of CRT on MR and assessed the determinants of exercise-induced changes in MR under biventricular pacing.• • • This prospective study included 27 consecutive patients with heart failure who were clinically helped by biventricular pacing. Before CRT implantation, all were in New York Heart Association class III and had left ventricular ejection fractions Յ35%, functional MR, were in sinus rhythm, had QRS duration Ն140 ms, and had interventricular delay (the time interval between aortic and pulmonary valve opening) Ն50 ms. All patients underwent quantitative exercise Doppler echocardiography with and without active CRT. The causes of heart failure were idiopathic dilated cardiomyopathy in 9 patients and ischemic heart disease in 18. The protocol was approved by the human ethical committee of our university hospital, and all patients gave informed consent.A symptom-limited graded bicycle exercise test was performed in a semisupine position on a tilting exercise table. After an initial workload of 25 W maintained for 2 minutes, the workload was increased every 2 minutes by 25 W. Blood pressure and 12-lead electrocardiograms were recorded every 2 minutes. Two-dimensional and Doppler echocardiographic recordings were available throughout the test.Baseline and exercise echocardiographic studies were performed 45 Ϯ 16 days after implantation of the CRT system using the phased-array Acuson Sequoia (Siemens AG, Munich, Germany) or VIVID 7 (GE Healthcare, Little Chalfont, United Kingdom) imaging device. In 17 patients, after data acquisition during active CRT (CRT on), pacing was interrupted during 30 minutes before data acquisition during intrinsic conduction (CRT off). In the other 10 patients, data were first acquired with CRT off. All echocardiographic and Doppler recordings were obtained in digital format and stored on optical discs for off-line analysis. For each measurement, Ն3 cardiac cycles were averaged. The quantitation of MR was performed by the quantitative Doppler method using mitral and aortic stroke volumes and the proximal isovelocity surface area method, as previously described. 7,8 The results of these 2 methods were averaged, allowing the calculation of regurgitant volume and the effective regurgitant orifice (ERO). Left ventricular end-diastolic and end-systolic volumes and ejection fractions were measured by the bi-apical Simpson disk method. The left ventricular dP/dt was estimated from the steepest increasing segment of the continuous-

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mentioning

confidence: 99%

Effect of cardiac resynchronization therapy on functional mitral regurgitation in heart failure

Lancellotti¹,

Mélon²,

Sakalihasan

et al. 2004

The American Journal of Cardiology

102

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“…Breithardt et al directly ascribed the beneficial effect of cardiac resynchronization to improved myocardial performance and increased mitral valve closing forces. 24 Other effects of cardiac resynchronization might be of significance. Papillary muscle discoordination was observed in animals.…”

Section: Discussionmentioning

confidence: 99%

Asynchronous Movement of Mitral Annulus: An Additional Mechanism of Ischaemic Mitral Regurgitation

Szymański¹,

Klisiewicz²,

Hoffmań³

2007

Clinical Cardiology

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SummaryIn-coordinate mitral annulus movement might participate in the pathogenesis of functional mitral regurgitation. We evaluated a relationship between indices of mitral annulus systolic asynchrony and mitral regurgitation in patients after myocardial infarction in order to determine independent determinants of effective regurgitant orifice (ERO) area in a multivariate regression model.Tissue Doppler echocardiographic studies and quantitative analysis of mitral regurgitation were performed in 40 patients (33 men, 7 women, mean age 60.1 ± 9.2 years) with a history of Q-wave myocardial infarction, with and without significant functional mitral regurgitation.A multivariate regression model showed that mitral annulus movement asynchrony index-difference between the longest and the shortest time from the R wave in the electrocardiogram to the cessation of systolic movement of the four aspects of mitral annulus, is an independent from ejection fraction, sphericity index, tenting, annulus diameter and infarct location, determinant of mitral regurgitation ERO area (r 2 change 0.72, p 0.01). The only other independent predictor of ERO area was mitral annulus diameter (r 2 change 0.79, p 0.01). Other variables were predictors of ERO only in univariate analyses: ejection fraction (r 2 change 0.59, p 0.01), tenting area (r 2 change 0.76, p 0.01) and sphericity index (r 2 change 0.75, p 0.01).In conclusion, mitral annulus asynchrony is an additional mechanism contributing to the development of functional mitral regurgitation. This suggests, that cardiac resynchronization might be considered, either as a first line intervention in patients with mitral regurgitation not considered for mitral surgery or as a supplementary measure, when results of surgery are suboptimal.

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“…Long term bi-ventricular pacing is associated with a significant reduction in mitral regurgitation jet area (4,27), left ventricular mass, left ventricular end-systolic and end-diastolic dimensions of all indicative reverse remodeling (28)(29)(30). MIRACLE and Vigor-CHF have reported approximately 10 % of reductions in both end-systolic and end-diastolic volumes with 6-month CRT treatments (29,30).The effect on chamber volume persists, even after cessation of CRT pacing suggested a remodeling effect rather than an active effect of CRT.…”

Section: Chronic Effectsmentioning

confidence: 99%

Cardiac Resynchronisation Therapy in Heart Failure

Wahab¹,

Alvi²,

Panwar³

et al. 2011

Int Cardiovasc Res J

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This review is intended for those managing patients of heart failure and aims to provide the recent advances and emerging role of CRT implantation in heart failure management.Cardiac resynchronization therapy (CRT) represents one of the recent advances in heart failure (HF) management. It implies an attempt to establish left ventricular synchronous contraction in order to improve left ventricular hemodynamics; thereby improving functional class, and quality of life. CRT has come a long way from an incidental treatment modality to an accepted and indicated treatment strategy for patients suffering from severe and chronic heart failure. With its ever increasing use, it is important that we become conversant with its role in the management of heart failure. This article aims to review the evidence for CRT, how CRT benefits patients of heart failure and reveals the indications of CRT implantation in HF patients.

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Acute effects of cardiac resynchronization therapy on functional mitral regurgitation in advanced systolic heart failure

Cited by 462 publications

References 33 publications

Effect of cardiac resynchronization therapy on functional mitral regurgitation in heart failure

Effect of cardiac resynchronization therapy on functional mitral regurgitation in heart failure

Asynchronous Movement of Mitral Annulus: An Additional Mechanism of Ischaemic Mitral Regurgitation

Cardiac Resynchronisation Therapy in Heart Failure

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