Left Ventricular Response to Mitral Regurgitation

Gaasch, William H.; Meyer, Theo E.

doi:10.1161/circulationaha.107.755942

Cited by 230 publications

(165 citation statements)

References 47 publications

Supporting

Mentioning

145

Contrasting

Unclassified

Order By: Relevance

“…Contrary to the general notion, afterload tends to be high in chronic MR as a result of progressive ventricular enlargement, particularly in the decompensated stage. 20,32 Thus, an uncontrolled increase in LV afterload, also called afterload excess, is an important concern after MR correction because it may lead to further deterioration of LV function. Several studies have documented a significant increase in systolic LV load after successful mitral valve surgery in patients with chronic decompensated MR but not in the chronic compensated stage.…”

Section: Changes In LV Loading Conditionsmentioning

confidence: 99%

See 1 more Smart Citation

Real-Time Left Ventricular Pressure-Volume Loops During Percutaneous Mitral Valve Repair With the MitraClip System

Gaemperli¹,

Biaggi²,

Gugelmann³

et al. 2013

Circulation

105

View full text Add to dashboard Cite

Background— Percutaneous mitral valve repair with the MitraClip device has emerged as an alternative to surgery for treating severe mitral regurgitation. However, its effects on left ventricular loading conditions and contractility have not been investigated yet. Methods and Results— Pressure-volume loops were recorded throughout the MitraClip procedure using conductance catheter in 33 patients (mean age, 78±10 years) with functional (45%), degenerative (48%), or mixed (6%) mitral regurgitation. Percutaneous mitral valve repair increased end-systolic wall stress (WS ES ; from [median] 184 mm Hg [interquartile range (IQR), 140–200 mm Hg] to 209 mm Hg [IQR, 176–232 mm Hg]; P =0.001) and decreased end-diastolic WS (WS ED ; from 48 mm Hg [IQR, 28–58 mm Hg] to 34 mm Hg [IQR, 21–46 mm Hg]; P =0.005), whereas the end-systolic pressure-volume relationship was not significantly affected. Conversely, cardiac index increased (from 2.6 L·min −1 ·m −2 [IQR, 2.2–3.0 L·min −1 ·m −2 ] to 3.2 L·min −1 ·m −2 [IQR, 2.6–3.8 L·min −1 ·m −2 ]; P <0.001) and mean pulmonary capillary wedge pressure decreased (from 15 mm Hg [IQR, 12–20 mm Hg] to 12 mm Hg [IQR, 10–13 mm Hg]; P <0.001). Although changes in WS ES were not correlated with changes in cardiac index, changes in WS ED correlated significantly with changes in mean pulmonary capillary wedge pressure ( r =0.63, P <0.001). Total mechanical energy assessed by the pressure-volume area remained unchanged, resulting in a more favorable index of forward output (cardiac index) to mechanical energy (pressure-volume area) after mitral valve repair. On follow-up (153±94 days), New York Heart Association functional class was reduced from 2.9±0.6 to 1.9±0.5 ( P <0.001) at 3 months, and echocardiographic follow-up documented a stepwise reduction in end-diastolic volume (from 147 mL [IQR, 95–191 mL] to 127 mL [IQR, 82–202 mL]; P =0.036). Conclusions— Percutaneous mitral valve repair improves hemodynamic profiles and induces reverse left ventricular remodeling by reducing left ventricular preload while preserving contractility. In nonsurgical candidates with compromised left ventricular function, MitraClip therapy could be considered an alternative to surgical mitral valve repair.

show abstract

Section: Changes In LV Loading Conditionsmentioning

confidence: 99%

“…32,35 These patients represent a challenge to available treatment options because LV changes may have reached an irreversible stage when outcomes of surgical interventions are poor. 36 Therefore, it is crucial to avoid interventions that will lead to further deterioration of LV contractility.…”

Section: Effects Of Percutaneous Mvr On LV Contractilitymentioning

confidence: 99%

Real-Time Left Ventricular Pressure-Volume Loops During Percutaneous Mitral Valve Repair With the MitraClip System

Gaemperli¹,

Biaggi²,

Gugelmann³

et al. 2013

Circulation

105

View full text Add to dashboard Cite

show abstract

“…17 Most available evidence regards the association of decreased preoperative EF with increased postoperative occurrence of LV dysfunction, heart failure, and death. 1,4,6,7,16,18 Accordingly, despite physiological reluctance to use EF in the context of MR, it has been clinically recognized as providing value in clinical decision making 19 and reduced (≤60%) EF is currently a class I indication for considering mitral surgery. 2,3 In contrast to apparently coherent guidelines, recent registry data show that too often patients with severe MR and overt LV dysfunction based on low EF are still not referred to surgery and are exposed to unacceptably high risk of death with medical management.…”

Section: Discussionmentioning

confidence: 99%

Long-Term Mortality Associated With Left Ventricular Dysfunction in Mitral Regurgitation Due to Flail Leaflets

Tribouilloy

Ruşinaru

Grigioni

et al. 2014

Circ: Cardiovascular Imaging

View full text Add to dashboard Cite

show abstract

“…The proof of LV remodeling after MC implantation is important in the subgroup of patients with MR and severely reduced LV function: Chronic volume overload in MR is related to remodeling of the extracellular matrix with dissolution of collagen tissue and consecutive rearrangement and slippage of myocardial fibers [25,26]. Subsequent decompensation is characterized by progressive LV dilation, elevated diastolic LV pressure, increased systolic wall stress and reduced LV ejection fraction [27]. The poor outcome of mitral valve surgery in patients with severely reduced LV function could be potentially related to irreversible changes in the extracellular matrix as well as a result of the underlying disease such as dilative cardiomyopathy or MR itself [2].…”

Section: Reverse LV Remodelingmentioning

confidence: 99%

Cardiac Remodeling Following Percutaneous Mitral Valve Repair – Initial Results Assessed by Cardiovascular Magnetic Resonance Imaging

Radunski¹,

Franzen

Barmeyer

et al. 2014

Fortschr Röntgenstr

View full text Add to dashboard Cite

Purpose: Percutaneous mitral valve repair with the MitraClip device (Abbott Vascular, Redwood City, California, USA) is a novel therapeutic option in patients with mitral regurgitation. This study evaluated the feasibility of cardiac volume measurements by cardiovascular magnetic resonance imaging (CMR) to assess reverse myocardial remodeling in patients after MitraClip implantation. Materials and Methods: 12 patients underwent CMR at baseline (BL) before and at 6 months follow-up (FU) after MitraClip implantation. Cine-CMR was performed in short- and long-axes for the assessment of left ventricular (LV), right ventricular (RV) and left atrial (LA) volumes. Results: Assessment of endocardial contours was not compromised by the device-related artifact. No significant differences in observer variances were observed for LV, RV and LA volume measurements between BL and FU. LV end-diastolic (median 127 [IQR 96???150] vs. 112 [86???150] ml/m2; p?=?0.03) and LV end-systolic (82 [54???91] vs. 69 [48???99] ml/m2; p?=?0.03) volume indices decreased significantly from BL to FU. No significant differences were found for RV end-diastolic (94 [75???103] vs. 99 [77???123] ml/m2; p?=?0.91), RV end-systolic (48 [42???80] vs. 51 [40???81] ml/m2; p?=?0.48), and LA (87 [55???124] vs. 92 [48???137] ml/m2; p?=?0.20) volume indices between BL and FU. Conclusion: CMR enables the assessment of cardiac volumes in patients after MitraClip implantation. Our CMR findings indicate that percutaneous mitral valve repair results in reverse LV but not in RV or LA remodeling. Key points: ??Volume measurements by cardiovascular magnetic resonance imaging are feasible following percutaneous mitral valve repair despite device-related artifacts. ??A significant reduction of left ventricular volume was found in terms of beneficial, reverse left ventricular remodeling after 6-month follow-up. ??No significant reduction was found in right ventricular or left atrial volumes after percutaneous mitral valve repair after 6-month follow-up. Citation Format: ??Radunski UK, Franzen O, Barmeyer A et?al. Cardiac Remodeling Following Percutaneous Mitral Valve Repair ? Initial Results Assessed by Cardiovascular Magnetic Resonance Imaging. Fortschr R?ntgenstr 2014; 186: 951???958

show abstract

Left Ventricular Response to Mitral Regurgitation

Cited by 230 publications

References 47 publications

Real-Time Left Ventricular Pressure-Volume Loops During Percutaneous Mitral Valve Repair With the MitraClip System

Real-Time Left Ventricular Pressure-Volume Loops During Percutaneous Mitral Valve Repair With the MitraClip System

Long-Term Mortality Associated With Left Ventricular Dysfunction in Mitral Regurgitation Due to Flail Leaflets

Cardiac Remodeling Following Percutaneous Mitral Valve Repair – Initial Results Assessed by Cardiovascular Magnetic Resonance Imaging

Contact Info

Product

Resources

About