TY - JOUR
T1 - Predictors of mitral regurgitation recurrence in patients with heart failure undergoing mitral valve annuloplasty
AU - Ciarka, Agnieszka
AU - Braun, Jerry
AU - Delgado, Victoria
AU - Versteegh, Michel
AU - Boersma, Eric
AU - Klautz, Robert
AU - Dion, Robert
AU - Bax, Jeroen J.
AU - Van De Veire, Nico
N1 - Funding Information: Dr. Ciarka received a training grant in noninvasive imaging in cardiology from the European Society of Cardiology (Sophia Antipolis, France) and a grant from the Horlait-Dapsens Foundation (Brussels, Belgium). Dr. Bax received grants from Biotronik (Berlin, Germany), Medtronic (Minneapolis, Minnesota), Boston Scientific Corporation (Natic, Massachusetts), Bristol-Myers Squibb Medical Imaging (New York, New York), St Jude Medical (St. Paul, Minnesota), GE Healthcare (Milwaukee, Wisconsin), and Edwards Lifesciences (Irving, California). Dr. Dion is on the speakers' bureau of Edwards Lifesciences (Irving, California).
PY - 2010/8/1
Y1 - 2010/8/1
N2 - Restrictive mitral annuloplasty is a surgical treatment option for patients with heart failure (HF) and functional mitral regurgitation (MR). However, recurrent MR has been reported at mid-term follow-up. The aim of the present study was to identify the echocardiographic predictors of recurrent MR in patients with HF undergoing mitral annuloplasty. During a mean follow-up of 2.6 ± 1.6 years, 109 patients with HF (49% ischemic and 51% idiopathic dilated cardiomyopathy) who had undergone mitral valve repair were followed up (of 122 total patients). The severity of MR was quantified, and the following parameters were measured before intervention and at the mid-term follow-up examination: left ventricular (LV) and left atrial volumes and dimensions, LV sphericity index, mitral annular area, and mitral valve geometry parameters. At mid-term follow-up, 21 patients presented with significant MR (grade 2 to 4), and 88 patients had only MR grade 0 to 1. Both groups of patients had had a similar preoperative MR grade, mitral annular area, and LV volume and dimension. In contrast, patients with recurrent MR had had increased preoperative posterior and anterior leaflet angles, tenting height, tenting area, and LV sphericity index compared to the patients without recurrent MR. Of the different parameters of mitral and LV geometry, the distal mitral anterior leaflet angle (hazard ratio 1.48, 95% confidence interval 1.32 to 1.66, p <0.001) and posterior leaflet angle (hazard ratio 1.13, 95% confidence interval 1.07 to 1.19, p <0.001) were independent determinants of MR at mid-term follow-up. In conclusion, in patients with HF of ischemic or idiopathic etiology and functional MR, distal mitral leaflet tethering and posterior mitral leaflet tethering were associated with recurrent MR after restrictive mitral annuloplasty.
AB - Restrictive mitral annuloplasty is a surgical treatment option for patients with heart failure (HF) and functional mitral regurgitation (MR). However, recurrent MR has been reported at mid-term follow-up. The aim of the present study was to identify the echocardiographic predictors of recurrent MR in patients with HF undergoing mitral annuloplasty. During a mean follow-up of 2.6 ± 1.6 years, 109 patients with HF (49% ischemic and 51% idiopathic dilated cardiomyopathy) who had undergone mitral valve repair were followed up (of 122 total patients). The severity of MR was quantified, and the following parameters were measured before intervention and at the mid-term follow-up examination: left ventricular (LV) and left atrial volumes and dimensions, LV sphericity index, mitral annular area, and mitral valve geometry parameters. At mid-term follow-up, 21 patients presented with significant MR (grade 2 to 4), and 88 patients had only MR grade 0 to 1. Both groups of patients had had a similar preoperative MR grade, mitral annular area, and LV volume and dimension. In contrast, patients with recurrent MR had had increased preoperative posterior and anterior leaflet angles, tenting height, tenting area, and LV sphericity index compared to the patients without recurrent MR. Of the different parameters of mitral and LV geometry, the distal mitral anterior leaflet angle (hazard ratio 1.48, 95% confidence interval 1.32 to 1.66, p <0.001) and posterior leaflet angle (hazard ratio 1.13, 95% confidence interval 1.07 to 1.19, p <0.001) were independent determinants of MR at mid-term follow-up. In conclusion, in patients with HF of ischemic or idiopathic etiology and functional MR, distal mitral leaflet tethering and posterior mitral leaflet tethering were associated with recurrent MR after restrictive mitral annuloplasty.
UR - http://www.scopus.com/inward/record.url?scp=77955463308&partnerID=8YFLogxK
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=77955463308&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/20643253
U2 - https://doi.org/10.1016/j.amjcard.2010.03.042
DO - https://doi.org/10.1016/j.amjcard.2010.03.042
M3 - Article
C2 - 20643253
SN - 0002-9149
VL - 106
SP - 395
EP - 401
JO - American Journal of Cardiology
JF - American Journal of Cardiology
IS - 3
ER -