Loss of left ventricular rotation is a significant determinant of functional mitral regurgitation

2021 ◽  
Author(s):  
Tal Hasin ◽  
Daniel Mann ◽  
Michael Welt ◽  
Orit Barrett ◽  
Aryeh Shalev ◽  
...  
Keyword(s):  
Mitral Regurgitation ◽  
Left Ventricular ◽  
Functional Mitral Regurgitation ◽  
Significant Determinant

The Results of the Use of Angiotensin Receptor Inhibitors and Neprilisin in Secondary Functional Mitral Regurgitation in Outpatient Practice

2020 ◽  
Vol 75 (5) ◽  
pp. 514-522
Author(s):  
Alexey S. Ryazanov ◽  
Konstantin I. Kapitonov ◽  
Mariya V. Makarovskaya ◽  
Alexey A. Kudryavtsev
Keyword(s):  
Heart Failure ◽  
Left Ventricle ◽  
Mitral Regurgitation ◽  
Effective Area ◽  
Left Ventricular ◽  
Functional Mitral Regurgitation ◽  
Angiotensin Receptor ◽  
Optimal Drug ◽  
Patients With Heart Failure ◽  
Valsartan Group

Background. Morbidity and mortality in patients with functional mitral regurgitation (FMR) remains high, however, no pharmacological therapy has been proven to be effective.Aimsto study the effect of sacubitrile/valsartan and valsartan on functional mitral regurgitation in chronic heart failure.Methods.This double-blind study randomly assigned sacubitrile/valsartan or valsartan in addition to standard drug therapy for heart failure among 100 patients with heart failure with chronic FMR (secondary to left ventricular (LV) dysfunction). The primary endpoint was a change in the effective area of the regurgitation hole during the 12-month follow-up. Secondary endpoints included changes in the volume of regurgitation, the final systolic volume of the left ventricle, the final diastolic volume of the left ventricle, and the area of incomplete closure of the mitral valves.Results.The decrease in the effective area of the regurgitation hole was significantly more pronounced in the sacubitrile/valsartan group than in the valsartan group (0.070.066against0.030.058sm2; p=0.018)in the treatment efficacy analysis, which included 100patients (100%). The regurgitation volume also significantly decreased in the sacubitrile/valsartan group compared to the valsartan group (mean difference:8.4ml; 95%CI, from 13.2 until 1.9;р=0.21). There were no significant differences between the groups regarding changes in the area ofincomplete closure of the mitral valves and LV volumes, with the exception of the index of the final LV diastolic volume (p=0.07).Conclusion.Among patients with secondary FMR, sacubitril/valsartan reduced MR more than valsartan. Thus, angiotensin receptor inhibitors and neprilysin can be considered for optimal drug treatment of patients with heart failure and FMR.

scholarly journals Ventricular arrhythmias in patients with functional mitral regurgitation and implantable cardiac devices: implications of mitral valve repair with Mitraclip

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
T Benito Gonzalez ◽  
X Freixa ◽  
C Godino ◽  
M Taramasso ◽  
R Estevez-Loureiro ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Mitral Valve Repair ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Functional Mitral Regurgitation ◽  
Valve Repair ◽  
One Year ◽  
The Impact

Abstract Background Limited information has been reported regarding the impact of percutaneous mitral valve repair (PMVR) on ventricular arrhythmic (VA) burden. The aim of this study was to address the incidence of VA and appropriate antitachycardia implantable cardiac defibrillator (ICD) therapies before and after PMVR. Methods We retrospectively analyzed all consecutive patients with heart failure with reduce left ventricular ejection fraction, functional mitral regurgitation grade 3+ or 4+ and an active ICD or cardiac resynchronizer who underwent PMVR in any of the eleven recruiting centers. Only patients with complete available device VA monitoring from one-year before to one year after PMVR were included. Baseline clinical and echocardiographic characteristics were collected before PMVR and at 12-months follow-up. Results 93 patients (68.2±10.9 years old, male 88.2%) were enrolled. PMVR was successfully performed in all patients and device success at discharge was 91.4%. At 12-months follow-up, we observed a significant reduction in mitral regurgitation severity, NT-proBNP and prevalence of severe pulmonary hypertension and severe kidney disease. Patients also referred a significant improvement in NYHA functional class and showed a non-significant trend to reserve left ventricular remodeling. After PMVR a significant decrease in the incidence of non-sustained ventricular tachycardia (VT) (5.0–17.8 vs 2.7–13.5, p=0.002), sustained VT or ventricular fibrillation (0.9–2.5 vs 0.5–2.9, p=0.012) and ICD antitachycardia therapies (2.5–12.0 vs 0.9–5.0, p=0.033) were observed. Conclusion PMVR was related to a reduction in arrhythmic burden and ICD therapies in our cohort. Proportion of patients who presented ven Funding Acknowledgement Type of funding source: None

scholarly journals Aggravation of functional mitral regurgitation on left ventricle stiffness in type 2 diabetes mellitus patients evaluated by CMR tissue tracking

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Yi Zhang ◽  
Wei-feng Yan ◽  
Li Jiang ◽  
Meng-ting Shen ◽  
Yuan Li ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Mitral Regurgitation ◽  
Strain Rate ◽  
Left Ventricular ◽  
Functional Mitral Regurgitation ◽  
Lv Function ◽  
Peak Strain

Abstract Background Functional mitral regurgitation (FMR) is one of the most common heart valve diseases in diabetes and may increase left ventricular (LV) preload and aggravate myocardial stiffness. This study aimed to investigate the aggravation of FMR on the deterioration of LV strain in type 2 diabetes mellitus (T2DM) patients and explore the independent indicators of LV peak strain (PS). Materials and methods In total, 157 T2DM patients (59 patients with and 98 without FMR) and 52 age- and sex-matched healthy control volunteers were included and underwent cardiac magnetic resonance examination. T2DM with FMR patients were divided into T2DM patients with mild (n = 21), moderate (n = 19) and severe (n = 19) regurgitation. LV function and global strain parameters were compared among groups. Multivariate analysis was used to identify the independent indicators of LV PS. Results The T2DM with FMR had lower LV strain parameters in radial, circumferential and longitudinal direction than both the normal and the T2DM without FMR (all P < 0.05). The mild had mainly decreased peak diastolic strain rate (PDSR) compared to the normal. The moderate had decreased peak systolic strain rate (PSSR) compared to the normal and PDSR compared to the mild and the normal. The severe FMR group had decreased PDSR and PSSR compared to the mild and the normal (all P < 0.05). Multiple linear regression showed that the regurgitation degree was independent associated with radial (β = − 0.272), circumferential (β = − 0.412) and longitudinal (β = − 0.347) PS; the months with diabetes was independently associated with radial (β = − 0.299) and longitudinal (β = − 0.347) PS in T2DM with FMR. Conclusion FMR may aggravate the deterioration of LV stiffness in T2DM patients, resulting in decline of LV strain and function. The regurgitation degree and months with diabetes were independently correlated with LV global PS in T2DM with FMR.

Abstract 17145: Mitral Leaflet Growth and its Relationship with Functional Mitral Regurgitation in Non-ischemic Left Ventricular Systolic Dysfunction

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Yu Kang ◽  
Xiao-Jing Chen ◽  
Qing Zhang ◽  
Xiao-Ling Sun ◽  
Yu-Chen Chen ◽  
...  
Keyword(s):  
Mitral Regurgitation ◽  
Left Ventricular Systolic Dysfunction ◽  
Systolic Dysfunction ◽  
Normal Subjects ◽  
Left Ventricular ◽  
Area Ratio ◽  
Functional Mitral Regurgitation ◽  
Mitral Leaflet ◽  
Significant Difference ◽  
Annular Dilation

Backgrounds: Recent studies evidenced growth of the mitral leaflet (ML) in patients with functional mitral regurgitation (FMR), casting doubt on the traditional understanding of FMR. The aim of this study was to explore whether growth of ML occurs in patients with non-ischemic left ventricular (LV) systolic dysfunction and to examine whether there was any relationship between the growth of ML and the development of FMR. Methods: Echocardiographic examination was performed in 3 groups of patients: patients with non-ischemic LV systolic dysfunction [LV ejection fraction (EF) <50%] and significant FMR (MR jet area ratio≥20%) (group1, n=40), patients with non-ischemic LV systolic dysfunction but no significant FMR (MR jet area ratio <20%) (group2, n=30), and normal subjects (group3, n=40). The lengths of the anterior (AML) and posterior (PML) mitral leaflets as well as the anterior-posterior mitral annular dimension (MAD) were measured to reflect the degree of ML growth and mitral annular dilation. The ratio of AML and PML to MAD (AML: MAD, PML: MAD) were calculated respectively to assess the adequacy of ML growth in the context of mitral annular dilation. Results: The AML, PML, and the MAD were all increased in patients with LV systolic dysfunction (group1 and group2) compared with normal subjects (group3). In patients with LV systolic dysfunction, both PML and MAD were further increased in group1 compared with group2. However, AML showed no significant difference between the 2 groups. As a result, PML:MAD showed no significant difference between group1 and group2, while AML:MAD was significantly decreased in group1 compared with group2 (Table 1). Conclusion: Mitral leaflet growth occurs in patients with non-ischemic LV systolic dysfunction. Insufficient growth of the anterior mitral leaflet relative to dilated mitral annulus is associated with the development of significant FMR.

Abstract 4827: Role of Left Ventricular Dyssynchrony in Functional Mitral Regurgitation in Patients with Dilated Cardiomyopathy: A Comparison Study with Geometric Parameters of Mitral Apparatus Estimated with 3d Echocardiography

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Woonggil Choi ◽  
Soohyun Kim ◽  
Seongill Woo ◽  
Deahyuk Kim ◽  
Keumsoo Park ◽  
...  
Keyword(s):  
Mitral Regurgitation ◽  
Dilated Cardiomyopathy ◽  
Multivariate Regression Analysis ◽  
Tissue Doppler ◽  
Left Ventricular ◽  
Geometric Parameters ◽  
Functional Mitral Regurgitation ◽  
Left Ventricular Dyssynchrony ◽  
Lv Dyssynchrony ◽  
Mitral Apparatus

Objective: Functional mitral regurgitation (FMR) occurs commonly in patients with dilated cardiomyopathy (DCM). The aim of this study was to compare the roles of Left Ventricle(LV) dyssynchrony and geometric parameters of mitral apparatus as determinants of FMR in patients with DCM. Methods: Fourteen DCM patients without FMR and 15 DCM patients with FMR (ERO = 0.11 ± 0.029 cm 2 ) were enrolled. Effective regurgitant orifice (ERO) area and tissue Doppler-derived dyssynchrony index (DI: the standard deviation of time to peak myocardial systolic contraction of eight segments) were measured. The estimated DIs were corrected by the cycle length (CL) of each patient (cDI (%) = DI/CL*100). Using real-time 3D echocardiogrphy, mitral tenting area (MVT) and the degrees of displacement of anterior (APMD) and posterior (PPMD) papillary muscles were estimated. All geometric measurements were corrected (c) by the height of each patient. Results: There was no significant (p > 0.05) difference in LV Ejection Fraction and cLVEDV between two patient groups. cDI, cMVT, cAPMD and cPPMD significantly (p < 0.05) increased in the patient with FMR comparing with those in patients without FMR. cDI (r = 0.42), cMVT (r = 0.74), cAPMD (r = 0.63) and cPPMD (r = 0.64) showed significant (p < 0.05) correlations with ERO. cMVT was found to the strongest independent predictor of ERO with multivariate regression analysis, whereas cDI did not enter into the model. Conclusions: The degree of MV tenting rather than LV dyssynchrony was found to be the main determinant of FMR in DCM. However LV dyssynchrony also has a minor independent association with FMR.

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