Left Ventricular Reverse Remodeling After Undersized Mitral Ring Annuloplasty in Patients With Ischemic Regurgitation

Gelsomino, Sandro; Lorusso, Roberto; Capecchi, Irene; Rostagno, Carlo; Romagnoli, Stefano; Billè, Giuseppe; Cicco, Giuseppe De; Tetta, Cecilia; Stefàno, Pierluigi; Gensini, Gian Franco

doi:10.1016/j.athoracsur.2007.12.074

Cited by 54 publications

(56 citation statements)

References 34 publications

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“…The present study population, however, consisted only of patients with advanced or end-stage cardiomyopathy, which is the most difficult to treat with RMA. The patients with less LV remodeling and ischemic MR due to predominant inferior/posterior myocardial infarction, who were often included in the previous studies, 16,20-24, 26 were excluded from the present study.…”

Section: Study Limitationsmentioning

confidence: 99%

“…16, 23 In a recent study by Gelsomino et al, myocardial performance index, systolic sphericity index, and wall motion score index were independent predictors of reverse remodeling. 26 Because all these variables correlated with severity or extent of LV remodeling, it is logical that these "myocardial factors" are associated with postoperative outcome in patients with advanced cardiomyopathy. The present data provide additional evidence that hemodynamic parameters were also an important predictive marker of postoperative adverse outcomes.…”

Section: Predictors Of Postoperative Adverse Cardiac Events: Impact Omentioning

confidence: 99%

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Restrictive Mitral Annuloplasty for Functional Mitral Regurgitation - Acute Hemodynamics and Serial Echocardiography -

Kainuma

Taniguchi

Toda

et al. 2011

Circ J

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Background: Long-term effects of restrictive mitral annuloplasty (RMA), especially on hemodynamics and left ventricular (LV) function in patients with functional mitral regurgitation (MR), have not been fully investigated. Methods and Results:From 1999 to 2008, 44 patients with refractory heart failure and functional MR underwent RMA with stringent downsizing of the mitral annulus. Serial echocardiography was performed to evaluate LV function (reverse remodeling), estimated systolic pulmonary artery pressure (PAP) and mitral valve geometry at baseline and at discharge, and annually thereafter. Cardiac catheterization was performed at baseline, and at discharge to evaluate acute hemodynamic change. There were 3 early deaths, and the 5-year survival rate was 78±8%. In 41 survivors the clinical symptoms, stratified according to New York Heart Association class, significantly improved after surgery. Postoperative cardiac catheterization showed significant unloading for left ventricle, as well as improvement in LV systolic function. Serial echocardiography showed that improvements in LV function and systolic PAP were sustained in the majority of patients. Multivariate Cox regression analysis identified preoperative pulmonary hypertension (systolic PAP >60 mmHg) as the significant predictor for postoperative adverse cardiac events. Conclusions:RMA for functional MR resulted in sustained improvement of hemodynamics and LV function over time. Additional studies are needed to define the negative impact of preoperative pulmonary hypertension in patients with this condition. (Circ J 2011; 75: 571 - 579)

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Section: Study Limitationsmentioning

confidence: 99%

Section: Predictors Of Postoperative Adverse Cardiac Events: Impact Omentioning

confidence: 99%

Restrictive Mitral Annuloplasty for Functional Mitral Regurgitation - Acute Hemodynamics and Serial Echocardiography -

Kainuma

Taniguchi

Toda

et al. 2011

Circ J

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“…Echocardiography was used as an instrumental method of the evaluation of heart cavities sizes and for the calculation of their indexed values. Despite obvious benefits of this method of study, it has low reproducibility of results, which varies within 20% from obtained values (Geidel, 2005;Gelsomino, 2008).…”

Section: Fig 7 a Capillary From LV Myocardium Of An Icmp Patient: Cmentioning

confidence: 99%

Morphological Predictors and Molecular Markers of Progressing Postoperative Remodeling of Left Ventricle in Patients with Ischemic Cardiomyopathy

Шипулин¹,

Казаков²,

Лежнев³

et al. 2012

Front Lines of Thoracic Surgery

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“…However, a wide array of data has shown MR improvement to be linked to LV reverse remodeling (57)(58)(59). In this regard, the predictive utility of viability assessment via CMR is well established: transmural extent of viable myocardium on CMR is well known to predict LV reverse remodeling following surgical or percutaneous (PCI) revascularization (60).…”

Section: Prediction and Monitoring Of Mr Therapeutic Responsementioning

confidence: 99%

Utility of cardiac magnetic resonance for evaluation of mitral regurgitation prior to mitral valve surgery

et al. 2017

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Mitral regurgitation (MR) is a common cause of morbidity worldwide and an accepted indication for interventional therapies which aim to reduce or resolve adverse clinical outcomes associated with MR.Cardiac magnetic resonance (CMR) provides highly accurate means of assessing MR, including a variety of approaches that can measure MR based on quantitative flow. Additionally, CMR is widely accepted as a reference standard for cardiac chamber quantification, enabling reliable detection of subtle changes in cardiac chamber size and function so as to guide decision-making regarding timing of mitral valve directed therapies. Beyond geometric imaging, CMR enables tissue characterization of ischemia and infarction in the left ventricular (LV) myocardium as well as within the mitral valve apparatus, thus enabling identification of structural substrates for MR. This review provides an overview of established and emerging CMR approaches to measure valvular regurgitation, including relative utility of different approaches for patients with primary or secondary MR. Clinical outcomes studies are discussed with focus on data demonstrating advantages of CMR for guiding diagnosis, risk stratification, and management of patients with known or suspected MR. Comparative data is reviewed with focus on diagnostic performance of CMR in comparison to conventional assessment via echocardiography (echo). Emerging literature is reviewed concerning potential new approaches that utilize CMR tissue characterization to guide clinical decision-making in order to improve therapeutic outcomes and clinical prognosis for patients with MR. J Thorac Dis 2017;9(Suppl 4):S246-S256 jtd.amegroups.com pre-operative morbidity and decreases procedural efficacy (9,10), possibly due to impact of LV or left atrial (LA) dilation on mitral apparatus geometry or wall stress (11-13). Accordingly, consensus guidelines recommend surgery for patients with severe primary MR if symptoms are present or, in the case of asymptomatic individuals, if LV dysfunction (ejection fraction <60%) or chamber dilation (end-systolic diameter ≥40 mm) is present (14). Echocardiography (echo) is widely used to guide decision-making concerning timing of interventional therapies for MR (14). However, echo can be suboptimal for this purpose, as image quality can vary (15), chamber quantification is typically predicated on 2-dimensional (2D) geometric assumptions [rather than 3-dimensional (3D) imaging] (16), and MR quantification can be challenging in the context of regurgitant jet eccentricity (17). These limitations may explain recent data suggesting lack of correlation between pre-operative echo-quantified MR severity and LV reverse remodeling after mitral valve surgery (18). Knowledge gaps regarding predictors of procedural success limit the ability to optimize decision-making for patients with MR.Cardiac magnetic resonance (CMR) can assess MR as well as its predisposing risk factors. A variety of CMR pulse sequences can be used for MR assessment ( Table 1). Phase velocity en...

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Left Ventricular Reverse Remodeling After Undersized Mitral Ring Annuloplasty in Patients With Ischemic Regurgitation

Cited by 54 publications

References 34 publications

Restrictive Mitral Annuloplasty for Functional Mitral Regurgitation - Acute Hemodynamics and Serial Echocardiography -

Restrictive Mitral Annuloplasty for Functional Mitral Regurgitation - Acute Hemodynamics and Serial Echocardiography -

Morphological Predictors and Molecular Markers of Progressing Postoperative Remodeling of Left Ventricle in Patients with Ischemic Cardiomyopathy

Utility of cardiac magnetic resonance for evaluation of mitral regurgitation prior to mitral valve surgery

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