PREDICTORS OF HEART FAILURE DEVELOPMENT IN ATRIAL FIBRILLATION PATIENTS WITH FUNCTIONAL MITRAL REGURGITATION

Abstract Background The optimal treatment for patients with nonparoxysmal atrial fibrillation (AF) and heart failure with reduced ejection fraction (HFrEF) has been a subject of debate for years. We aimed to evaluate the efficacy and safety of catheter ablation (CA) of nonparoxysmal AF in patients with HFrEF and functional mitral regurgitation (MR). Methods This single-center, retrospective, and observational study enrolled 21 consecutive patients with nonparoxysmal AF, HFrEF and functional MR underwent CA༎The ablation strategy consisted of bilateral circumferential pulmonary vein isolation and empirical linear ablations. Results After a mean follow-up of 18.2 ± 8.5 months, stable sinus rhythm (SR) was achieved in 15 patients (71.4%) after the initial procedure and 17 patients (81%) after the final procedure. The NYHA class improved from 2.7 ± 0.7 before ablation to 1.2 ± 0.4 during follow-up (p < 0.001). Left ventricular ejection fraction increased from 36.5 ± 6.3% to 54.9 ± 6.6% (p < 0.001). Among 17 patients in continuous SR after the final procedure, MR severity decreased to mild or none,and 10 patients with decreased ventricular wall motion was completely restored to normal after the procedure. No serious complications occurred. Conclusion CA may be a safe and effective method for treating nonparoxysmal AF in patients with HFrEF and functional MR. It can significantly improve HF symptoms, functional MR and left ventricular function..

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553 Levosimendan improves diastolic function and reduces the degree of functional mitral regurgitation in patients with moderate heart failure

European Journal of Heart Failure Supplements ◽

10.1016/s1567-4215(07)60358-0 ◽

2007 ◽

Vol 6 (1) ◽

pp. 127-127

Author(s):

G BRANZI ◽

G MALFATTO ◽

F CIAMBELLOTTI ◽

M REVERA ◽

M FACCHINI ◽

...

Keyword(s):

Heart Failure ◽

Mitral Regurgitation ◽

Diastolic Function ◽

Functional Mitral Regurgitation ◽

Moderate Heart Failure

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

Annals of the Russian academy of medical sciences ◽

10.15690/vramn1462 ◽

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.

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Association between functional mitral regurgitation and recurrence of paroxysmal atrial fibrillation following catheter ablation: a prospective cohort study

Journal of International Medical Research ◽

10.1177/03000605211014375 ◽

2021 ◽

Vol 49 (5) ◽

pp. 030006052110143

Author(s):

Fusheng Ke ◽

Yinhui Huang ◽

Zhexiu Jin ◽

Lei Huang ◽

Qiang Xiong ◽

...

Keyword(s):

Atrial Fibrillation ◽

Risk Factor ◽

Cohort Study ◽

Catheter Ablation ◽

Mitral Regurgitation ◽

Confidence Interval ◽

Paroxysmal Atrial Fibrillation ◽

Prospective Cohort ◽

Radiofrequency Catheter Ablation ◽

Functional Mitral Regurgitation

Objective The present study aimed to investigate the effect of functional mitral regurgitation (FMR) on recurrence of paroxysmal atrial fibrillation (PAF) in patients undergoing radiofrequency catheter ablation. Methods This prospective cohort study comprised 107 patients with PAF. The patients were divided into the FMR and non-FMR groups. FMR was assessed by Doppler echocardiography before index ablation. All patients initially underwent circumferential pulmonary vein isolation (CPVI) and were followed up for 12 months after ablation. PAF, atrial tachycardia, or atrial flutter served as the endpoint indicator. Results The median duration of PAF was 24 (3–60) months. Binary logistic univariate and multivariate analyses showed that FMR was not a risk factor for recurrence of catheter ablation for PAF (hazard ratio=0.758, 95% confidence interval: 0.191–3.004; hazard ratio=0.665, 95% confidence interval: 0.134–3.300, respectively). Kaplan–Meier analysis showed no significant difference in the recurrence rate between the groups. Fifteen (15/107, 14%) cases of PAF were triggered by the pulmonary vein. Three (3/107, 2.8%) cases of PAF were triggered by the superior vena cava. Conclusions FMR is not an independent risk factor for predicting recurrence of catheter ablation for PAF. FMR does not affect patients undergoing radiofrequency catheter ablation for PAF.

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Percutaneous Mitral Valve Repair Vs. Stand-Alone Medical Therapy in Patients with Functional Mitral Regurgitation and Heart Failure

Cardiovascular Revascularization Medicine ◽

10.1016/j.carrev.2019.06.008 ◽

2020 ◽

Vol 21 (1) ◽

pp. 52-60 ◽

Cited By ~ 4

Author(s):

Tomás Benito-González ◽

Rodrigo Estévez-Loureiro ◽

Pedro A. Villablanca ◽

Patrizio Armeni ◽

Ignacio Iglesias-Gárriz ◽

...

Keyword(s):

Heart Failure ◽

Mitral Valve ◽

Mitral Regurgitation ◽

Mitral Valve Repair ◽

Medical Therapy ◽

Functional Mitral Regurgitation ◽

Valve Repair ◽

Percutaneous Mitral Valve Repair

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

European Journal of Echocardiography ◽

10.1016/j.euje.2005.03.008 ◽

2006 ◽

Vol 7 (1) ◽

pp. 31-39 ◽

Cited By ~ 41

Author(s):

M PORCIANI ◽

R MACIOCE ◽

G DEMARCHI ◽

M CHIOSTRI ◽

N MUSILLI ◽

...

Keyword(s):

Heart Failure ◽

Congestive Heart Failure ◽

Mitral Regurgitation ◽

Cardiac Resynchronization Therapy ◽

Cardiac Resynchronization ◽

Functional Mitral Regurgitation ◽

Resynchronization Therapy

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Abstract 13745: Severity of Functional Mitral Regurgitation During Maximal Exercise Testing in Heart Failure: Additional Value of Combining Echocardiography with Cardiopulmonary Exercise Testing

Circulation ◽

10.1161/circ.130.suppl_2.13745 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Greta Generati ◽

Francesco Bandera ◽

Marta Pellegrino ◽

Valentina Labate ◽

Eleonora Alfonzetti ◽

...

Keyword(s):

Heart Failure ◽

Mitral Regurgitation ◽

Ejection Fraction ◽

Exercise Testing ◽

Cardiopulmonary Exercise Testing ◽

Functional Mitral Regurgitation ◽

Peak Exercise ◽

Cardiopulmonary Exercise ◽

Pulmonary Hemodynamic ◽

Increased Risk

Background: In heart failure (HF) patients the severity of mitral regurgitation (MR) at rest has a well established prognostic value and its increase during exercise further adds to an increased risk. Our goal was to define the relationship between the degree of exercise MR severity with cardiopulmonary and echocardiographic related phenotypes in a cohort of HF patients. Methods: 71 HF reduced ejection fraction patients (mean age 67±11; male 72%; ischemic etiology 61%; NYHA class I, II, III and IV 13%, 36%, 39% and 12%, mean ejection fraction 33±9%) underwent cardiopulmonary exercise test (CPET) on tiltable cycle-ergometer combined with echocardiography at rest and during exercise. The population was divided into two groups according to the degree of functional peak MR: no to mild/moderate MR (no MR, MR1+ and MR2+) vs moderate/severe MR (MR3+ and MR4+). Results: A good correlation (ρ coefficient= 0.49) was found between the degree of dynamic MR and PASP at peak exercise. Despite similar echocardiographic profile at rest patients with significant peak MR (MR≥3+) had worse exercise performance (lower peak VO2, O2 pulse and workload) and impaired ventilatory efficiency (higher VE/VCO2 slope). Conclusions: In HF patients the severity of exercise-induced MR is associated with the most unfavorable performance and pulmonary hemodynamic response. A combined approach with CPET and echocardiographic assessment can help to early unmask and target functional MR and its related unfavorable phenotypes.

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