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Effect of cardiac resynchronization therapy on mitral valve geometry: a novel aspect as "reversed mitral remodeling"

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Abstract

Amelioration of the valvular geometry is a possible mechanism for mitral regurgitation (MR) improvement in patients receiving cardiac resynchronization therapy (CRT). We aimed to establish the precise definition, incidence, and predictors of reversed mitral remodeling (RMR), as well as the association with MR improvement and short-term CRT outcome. Ninety-five CRT recipients were retrospectively evaluated for the end-point of “MR response” defined as the absolute reduction in regurgitant volume (RegV) at 6 months. To identify RMR, changes in mitral deformation indices were tested for correlation with MR response and further analyzed for functional and echocardiographic CRT outcomes. Overall, MR response was observed in 50 patients (53%). Among the echocardiographic indices, the change in tenting area (TA) had the highest correlation with the change in RegV (r = 0.653, p < 0.001). The mean TA significantly decreased in MR responders (4.15 ± 1.05 to 3.67 ± 1.01 cm2 at 6 months, p < 0.001) and increased in non-responders (3.68 ± 1.04 to 3.98 ± 0.97 cm2, p = 0.014). The absolute TA reduction was used to identify patients with RMR (47%) which was found to be associated with higher rates of functional improvement (p = 0.03) and volumetric CRT response (p = 0.036) compared to those without RMR. Non-ischemic etiology and the presence of LBBB independently predicted RMR at multivariate analysis. In conclusion, reduction in TA is a reliable index of RMR, which relates to MR response, and functional and echocardiographic improvement with CRT. LBBB and non-ischemic etiology are independent predictors of RMR.

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Authors and Affiliations

  1. Cardiology Department, Faculty of Medicine, Medipol University, Tem Otoyolu Goztepe Cikisi No 1, Bagcilar, 34214, Istanbul, Turkey

    Oguz Karaca, Beytullah Cakal, Mehmet Onur Omaygenc, Haci Murat Gunes, Filiz Kizilirmak, Sinem Deniz Cakal, Deniz Dilan Naki, Irfan Barutcu & Bilal Boztosun

  2. Cardiac Electrophysiology Department, Faculty of Medicine, Medipol University, Istanbul, Turkey

    Fethi Kilicaslan

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  1. Oguz Karaca
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Correspondence to Oguz Karaca.

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Karaca, O., Cakal, B., Omaygenc, M.O. et al. Effect of cardiac resynchronization therapy on mitral valve geometry: a novel aspect as "reversed mitral remodeling". Int J Cardiovasc Imaging 34, 1029–1040 (2018). https://doi.org/10.1007/s10554-018-1308-2

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  • DOI: https://doi.org/10.1007/s10554-018-1308-2

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