Document Detail


Changes in mitral annular geometry and dynamics with ß-blockade in patients with degenerative mitral valve disease.
MedLine Citation:
PMID:  20847190     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: remodeling of the mitral annulus contributes to progression of mitral regurgitation (MR). In patients with moderate-to-severe MR, short-term treatment with β-blockers has been shown to increase left ventricular (LV) end-diastolic and end-systolic volume, and this could deleteriously increase mitral valve annular dimensions. The objective of this study was to quantify the effects of a short duration of β-blocker treatment on mitral annular dimensions and dynamics in patients with MR due to primary degenerative valve disease.
METHODS AND RESULTS: twenty-five patients with moderate-to-severe degenerative MR and normal LV systolic function were studied in a double-blind crossover experiment using a β1-selective adrenergic blocker and placebo administered for 14±3 days. Cardiac MRI images were acquired after each treatment period to quantify mitral annular dimensions. At end diastole, there was no change in annular area (1659±331 versus 1632±299 mm(2); P<0.19), annular perimeter (154.3±16.4 versus 152±13.9 mm; P<0.13), septal-lateral (SL) dimension (38.0±5 versus 39.0±4.5 mm; P<0.15), or annular height (9.8±3.8 versus 9.5±2.5 mm; P<0.53). β-blockade resulted in significant end-diastole decreases in commissure-commissure dimension (48.9±4.6 versus 47.2±4.0 mm; P<0.01) and eccentricity (1.3±0.2 versus 1.2±0.1; P<0.01). At end systole (ES), β-blockade conferred a small, but significant decrease in annular perimeter (161.0±19.3 versus 156.8±16.9 mm; P<0.04) and eccentricity (1.2±0.1 versus 1.1±0.1; P<0.02), and the SL dimension significantly increased (41.5±5.7 versus 43.0±5.3 mm; P<0.03). Commissure-commissure dimension, annular area, and annular height at ES were not significantly different.
CONCLUSIONS: despite significant increases in LV end-diastolic and end-systolic volume, short-term β-blocker treatment of patients with moderate-to-severe MR reduced or preserved all mitral annular dimensions except SL at ES.
Authors:
Daniel B Ennis; Gabriel R Rudd-Barnard; Bo Li; Carissa G Fonseca; Alistair A Young; Brett R Cowan; Ralph A H Stewart
Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't     Date:  2010-09-16
Journal Detail:
Title:  Circulation. Cardiovascular imaging     Volume:  3     ISSN:  1942-0080     ISO Abbreviation:  Circ Cardiovasc Imaging     Publication Date:  2010 Nov 
Date Detail:
Created Date:  2010-11-18     Completed Date:  2010-12-23     Revised Date:  2013-05-27    
Medline Journal Info:
Nlm Unique ID:  101479935     Medline TA:  Circ Cardiovasc Imaging     Country:  United States    
Other Details:
Languages:  eng     Pagination:  687-93     Citation Subset:  IM    
Affiliation:
Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, Calif. 90095, USA. daniel.ennis@gmail.com
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MeSH Terms
Descriptor/Qualifier:
Adrenergic beta-Antagonists / therapeutic use*
Cross-Over Studies
Double-Blind Method
Humans
Image Processing, Computer-Assisted / methods
Magnetic Resonance Imaging / methods
Metoprolol / therapeutic use*
Middle Aged
Mitral Valve / drug effects*,  physiopathology
Mitral Valve Insufficiency / drug therapy*,  physiopathology
Severity of Illness Index
Ventricular Function, Left / drug effects
Grant Support
ID/Acronym/Agency:
K99 HL087614-02/HL/NHLBI NIH HHS; K99-R00 HL-087614/HL/NHLBI NIH HHS; R00 HL087614-03/HL/NHLBI NIH HHS
Chemical
Reg. No./Substance:
0/Adrenergic beta-Antagonists; 37350-58-6/Metoprolol
Comments/Corrections

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