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Prevention of ischemic mitral regurgitation does not influence the outcome of remodeling after posterolateral myocardial infarction

T. Sloane Guy, IV, MD^*, Sina L. Moainie, MD^*, Joseph H. Gorman, III, MD^*, Benjamin M. Jackson, MD^*, Theodore Plappert, CVT, Yoshiharu Enomoto, MD^*, Martin G. St. John-Sutton, MBBS, FACC, L. Henry Edmunds, Jr, MD^* and Robert C. Gorman, MD^*,*

^* Harrison Department of Surgical Research, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA

View larger version (15K): [in a new window]   Figure 1 Degree of mitral regurgitation (MR) graded on a scale of 0 to 4 (0 = no MR, 4 = severe MR) in control group (squares), annuloplasty group (circles), and ventricular wrap group (triangles). By the nonparametric Kruskal-Wallis test with MR as the dependent variable and considering all experimental time points, the wrap, annuloplasty, and control groups are all significantly different (p < 0.05 for all comparisons).

View larger version (16K): [in a new window]   Figure 2 Normalized left ventricular end systolic volume (LVESV) in control group (squares), annuloplasty group (circles), and ventricular wrap group (triangles). The LVESV increased significantly in the control and annuloplasty groups at eight weeks but not in the wrap group. By analysis of variance, considering all experimental time points, the wrap group was significantly different from both the annuloplasty and the control groups. The annuloplasty group was not significantly different from the controls.

View larger version (17K): [in a new window]   Figure 3 End-systolic muscle-to-cavity-area ratio (ESMCAR) in control group (squares), annuloplasty group (circles), and ventricular wrap group (triangles). The ESMCAR did not change during postinfarction remodeling in the wrap group. By analysis of variance, considering all experimental time points, ESMCAR was significantly reduced in both the annuloplasty and control groups when compared with the wrap group. There was no significant difference between the control and annuloplasty groups.

View larger version (17K): [in a new window]   Figure 4 Length of the circumferential wall motion abnormality at the high papillary muscle level (WMA) in control group (squares), annuloplasty group (circles), and ventricular wrap group (triangles). By analysis of variance, considering all experimental time points, the WMA was significantly greater in the annuloplasty and control groups when compared to the wrap group. There was no statistical difference between the control and annuloplasty groups.

View larger version (18K): [in a new window]   Figure 5 Ejection fraction (EF) in control group (squares), annuloplasty (circles), and ventricular wrap group (triangles). By analysis of variance, considering all experimental time points, the EF in the annuloplasty group was significantly less than both the wrap and control groups. There was no statistical difference between the control and wrap groups.