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European Journal of Echocardiography 2006 7(1):31-39; doi:10.1016/j.euje.2005.03.008
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Copyright © 2005, The European Society of Cardiology

Effects of cardiac resynchronization therapy on the mechanisms underlying functional mitral regurgitation in congestive heart failure

Maria Cristina Porciani*, Roberto Macioce, Gabriele Demarchi, Marco Chiostri, Nicola Musilli, Francesco Cappelli, Alessio Lilli, Giuseppe Ricciardi and Luigi Padeletti

University of Florence, Institute of Internal Medicine and Cardiology, V. le Morgagni, 85, 50134 Florence, Italy

Received 5 November 2004; received in revised form 3 March 2005; accepted after revision 17 March 2005.

* Corresponding author. Tel.: +39 0554 277514. cporciani{at}hotmail.com


  Abstract

Aims Functional mitral regurgitation (FMR) improvement induced by cardiac resynchronization therapy (CRT) has been related to left ventricular (LV) remodeling reversal and contractility enhancement. The effects induced by the changes of LV synchronicity indexes on FMR severity have not been investigated.

Methods and results In 30 patients with CRT for heart failure (HF) and QRS >130ms, LV function parameters, FMR severity as mitral jet regurgitation/left atrial area ratio (JA/LAA) and standard deviation (SD) of the time to the systolic peak velocity at 6-basal and mid-LV segments as asynchrony indexes were evaluated (echo/tissue Doppler) before and 6 months after implant. At follow-up, 15 patients resulted responders to LV reverse remodeling with ≥15% end-systolic volume (ESV) and LV systolic function improvement. Improvement of FMR with ≥15% JA/LAA reduction was observed in 19 patients, 7 were nonresponders to LV reverse remodeling. In patients with ≥15% JA/LAA reduction a significant decrease of LV asynchrony indexes was observed as compared to patients without ≥15% JA/LAA reduction in whom LV asynchrony indexes were increased. Reduction of LV mid-segmental asynchrony was the variable most strongly related to JA/LAA reduction (r2=0.697, P<0.01), with good agreement between observed and predicted values (only 1 patient outside the mean±2SD).

Conclusion These data reveal that CRT can reduce FMR irrespective to LV remodeling reversal; this effect is related to LV asynchrony reduction and further support CRT employment in patients with HF and FMR.

Keywords: Functional mitral regurgitation; Cardiac resynchronization therapy; Left ventricular synchronicity; Left ventricular remodeling reversal; Tissue Doppler imaging


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