Document Detail

Early and late effects of cardiac resynchronization therapy on exercise-induced mitral regurgitation: relationship with left ventricular dyssynchrony, remodelling and cardiopulmonary performance.
MedLine Citation:
PMID:  17504802     Owner:  NLM     Status:  MEDLINE    
AIMS: Exercise-induced mitral regurgitation (MR) bears a poor prognosis in patients with congestive heart failure (CHF). Cardiac resynchronization therapy (CRT) is associated with improved clinical outcome but its effects on exercise-induced MR remain undetermined. We investigated serial changes in functional MR in relation to left ventricular (LV) remodelling and cardiopulmonary performance after CRT. METHODS AND RESULTS: Twenty-eight patients with CHF (LV ejection fraction 25 +/- 7%), broad QRS complex (171 +/- 27 ms), and at least mild MR [effective regurgitant orifice (ERO) 0.25 +/- 0.12 cm2] were studied with quantitative exercise echocardiography and cardiopulmonary exercise testing prior, within 1 week, and 3 months after CRT. Early after CRT, a decrease in LV dyssynchrony (from 54 +/- 21 to 19 +/- 7 ms, P < 0.001) and in MR at rest (ERO from 0.25 +/- 0.12 to 0.20 +/- 0.10 cm2, P = 0.047) was observed. However, no change in exercise-induced increase in MR was observed (ERO from 0.34 +/- 0.12 to 0.31 +/- 0.16 cm2, NS). Three months after CRT, a decrease in the mitral valve tenting area (from 3.3 +/- 1.2 to 2.0 +/- 0.6 cm2, P < 0.001) and an increase in LV sphericity index (from 1.5 +/- 0.3 to 1.8 +/- 0.5, P < 0.001) were paralleled by an attenuation of exercise-induced MR (ERO 0.19 +/- 0.06 cm(2), P = 0.001 vs. prior CRT). This was associated with an increase in LV ejection fraction (from 25 +/- 7 to 35 +/- 9%, P < 0.001), peak oxygen uptake (from 11.7 +/- 2.4 to 13.7 +/- 3.8 mL/kg/min, P = 0.001), and a decrease in Nt-pro-BNP (from 2777 +/- 1681 to 1963 +/- 1361 pg/mL, P = 0.067). CONCLUSION: CRT is associated with acute decrease in resting MR but does not immediately attenuate exercise-induced MR. In contrast, only late, CRT-induced reversed LV remodelling and reduced mitral apparatus deformation are associated with a reduction in both resting and exercise-induced MR and with an improvement in cardiopulmonary performance.
Juraj Madaric; Marc Vanderheyden; Christophe Van Laethem; Katia Verhamme; Ann Feys; Marc Goethals; Sofie Verstreken; Peter Geelen; Martin Penicka; Bernard De Bruyne; Jozef Bartunek
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2007-05-15
Journal Detail:
Title:  European heart journal     Volume:  28     ISSN:  0195-668X     ISO Abbreviation:  Eur. Heart J.     Publication Date:  2007 Sep 
Date Detail:
Created Date:  2007-09-03     Completed Date:  2008-06-17     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8006263     Medline TA:  Eur Heart J     Country:  England    
Other Details:
Languages:  eng     Pagination:  2134-41     Citation Subset:  IM    
Cardiovascular Center, OLV Ziekenhuis, Moorselbaan 164, BE-9300 Aalst, Belgium.
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MeSH Terms
Cardiac Pacing, Artificial / methods*
Echocardiography, Doppler
Exercise / physiology*
Exercise Test / methods
Heart Failure / physiopathology,  therapy*
Heart Function Tests / methods
Mitral Valve Insufficiency / etiology,  physiopathology,  prevention & control*
Oxygen Consumption / physiology
Pacemaker, Artificial
Ventricular Dysfunction, Left / physiopathology,  therapy*
Ventricular Remodeling / physiology

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