Recurrence of Mitral Regurgitation Parallels the Absence of Left Ventricular Reverse Remodeling After Mitral Repair in Advanced Dilated Cardiomyopathy

Bonis, Michele De; Lapenna, Elisabetta; Verzini, Alessandro; Canna, Giovanni La; Grimaldi, Antonio; Torracca, Lucia; Maisano, Francesco; Alfieri, Ottavio

doi:10.1016/j.athoracsur.2007.11.021

Cited by 145 publications

(97 citation statements)

References 10 publications

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“…Moderate or greater MR recurred in 67.5% of patients without LV reverse remodeling, and in 2.4% of those with reverse remodeling (P<0.001). Similar outcomes have also been reported in patients with secondary MR and non-ischemic dilated cardiomyopathy (37,38).…”

Section: Discussionsupporting

confidence: 71%

Mitral valve repair and subvalvular intervention for secondary mitral regurgitation: a systematic review and meta-analysis of randomized controlled and propensity matched studies

Mihos¹,

Xydas²,

Yucel³

et al. 2017

J. Thorac. Dis.

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Background: Combining a ring annuloplasty (Ring) with a mitral subvalvular intervention (Ring + subvalvular) in patients with secondary mitral regurgitation (MR) may improve mitral valve (MV) repair durability. However, the outcomes of this strategy compared with a Ring only, have not been clearly defined.Methods: A systematic review and meta-analysis was performed utilizing randomized controlled and propensity matched studies which compared a Ring + subvalvular versus Ring MV repair for the treatment of secondary MR. Risk ratio (RR), weighted mean difference (MD), and the 95% confidence interval (CI) were P=0.0001) and a greater ejection fraction (MD =2.64%, 95% CI, 0.13-5.15; P=0.04); and, (IV) an improved MV apparatus geometry. There were no differences in operative mortality, post-operative morbidity, or follow-up survival between surgical approaches. Conclusions: When compared with Ring only, a Ring + subvalvular MV repair is associated with greater LV reverse remodeling and systolic function, less recurrence of moderate or greater MR, and an improved geometry of the MV apparatus at short and mid-term follow-up.

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Section: Discussionsupporting

confidence: 71%

Mitral valve repair and subvalvular intervention for secondary mitral regurgitation: a systematic review and meta-analysis of randomized controlled and propensity matched studies

Mihos¹,

Xydas²,

Yucel³

et al. 2017

J. Thorac. Dis.

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“…De Bonis and colleagues [7] similarly reported two different patient responses to reduction annuloplasty for FMR. Long-term elimination of FMR occurred in those patients who responded with reverse remodeling, and mitral insufficiency recurred in those who had ongoing negative remodeling.…”

Section: Invited Commentarymentioning

confidence: 99%

Invited Commentary

Galloway

2010

The Annals 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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Recurrence of Mitral Regurgitation Parallels the Absence of Left Ventricular Reverse Remodeling After Mitral Repair in Advanced Dilated Cardiomyopathy

Cited by 145 publications

References 10 publications

Mitral valve repair and subvalvular intervention for secondary mitral regurgitation: a systematic review and meta-analysis of randomized controlled and propensity matched studies

Mitral valve repair and subvalvular intervention for secondary mitral regurgitation: a systematic review and meta-analysis of randomized controlled and propensity matched studies

Invited Commentary

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

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