CLINICAL RESEARCH: CARDIAC RESYNCHRONIZATION
Acute Effects of Initiation and Withdrawal of Cardiac Resynchronization Therapy on Papillary Muscle Dyssynchrony and Mitral Regurgitation
Claudia Ypenburg, MD*,
Patrizio Lancellotti, MD, PhD ,
Laurens F. Tops, MD*,
Gabe B. Bleeker, MD*,
Eduard R. Holman, MD, PhD*,
Luc A. Piérard, MD, PhD,
Martin J. Schalij, MD, PhD* and
Jeroen J. Bax, MD, PhD*,*
* Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
Department of Cardiology, University Hospital Sart Tilman, Liege, Belgium.
Manuscript received April 20, 2007;
revised manuscript received August 14, 2007,
accepted August 20, 2007.
* Reprint requests and correspondence: Dr. Jeroen J. Bax, Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands. (Email: jbax{at}ision.nl).
Objectives: The purpose of this study was to evaluate the relationship between dyssynchrony involving the mitral valve apparatus and the acute improvement in mitral regurgitation (MR) after cardiac resynchronization therapy (CRT). The effect of interruption of CRT at 6 months’ follow-up on dyssynchrony and MR was also evaluated.
Background: Mitral regurgitation may improve acutely after CRT, but the precise mechanism is not fully understood.
Methods: Out of 63 consecutive patients with baseline MR, 25 patients showed an acute reduction in MR severity immediately after CRT. This selected group of 25 patients (age 68 ± 10 years, left ventricular ejection fraction 23 ± 8%) was evaluated in the current study. Echocardiography including speckle tracking strain analysis was performed at baseline, after CRT initiation, and during interruption of CRT at 6 months’ follow-up to study the relationship between dyssynchrony between the papillary muscles and severity of MR.
Results: According to the inclusion criteria, all patients showed an immediate improvement in MR after CRT (vena contracta width decreased from 0.54 ± 0.15 cm to 0.39 ± 0.13 cm; p < 0.001), accompanied by an improvement in mitral deformation indexes. Furthermore, dyssynchrony between the papillary muscles decreased from 169 ± 69 ms to 25 ± 26 ms (p < 0.001). Importantly, these beneficial effects were maintained at 6 months’ follow-up, but acute loss of resynchronization (from 26 ± 28 ms to 134 ± 51 ms; p < 0.001) was observed after interruption of CRT, with an acute recurrence of MR and worsening in mitral deformation indexes.
Conclusions: Cardiac resynchronization therapy can acutely reduce MR in patients with dyssynchrony involving the papillary muscles; interruption of CRT at 6 months’ follow-up, however, resulted in acute loss of resynchronization with recurrence of MR.
|
Abbreviations and Acronyms
| | APM = anterior papillary muscle | | APM-PPM dyssynchrony = dyssynchrony between the anterior and posterior papillary muscles | | CRT = cardiac resynchronization therapy | | dP/dt = maximal rate of left ventricular systolic pressure increase | | LA = left atrial | | LV = left ventricular | | NYHA = New York Heart Association | | PPM = posterior papillary muscle | | PPM-fibrosa = distance between the posterior papillary muscle head and the intervalvular fibrosa |
|
This article has been cited by other articles:
|
|
|
|
 
F. Cabrera-Bueno, M. J. Molina-Mora, J. Alzueta, J. Pena-Hernandez, M. Jimenez-Navarro, J. Fernandez-Pastor, A. Barrera, and E. de Teresa
Persistence of secondary mitral regurgitation and response to cardiac resynchronization therapy
Eur J Echocardiogr,
November 24, 2009;
(2009)
jep184v1.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. Solis, D. McCarty, R. A. Levine, M. D. Handschumacher, L. Fernandez-Friera, A. Chen-Tournoux, L. Mont, B. Vidal, J. P. Singh, J. Brugada, et al.
Mechanism of Decrease in Mitral Regurgitation After Cardiac Resynchronization Therapy: Optimization of the Force-Balance Relationship
Circ Cardiovasc Imaging,
November 1, 2009;
2(6):
444 - 450.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. W.X. Foley, F. Leyva, and M. P. Frenneaux
What is treatment success in cardiac resynchronization therapy?
Europace,
November 1, 2009;
11(suppl_5):
v58 - v65.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
T. H Marwick, P. Lancellotti, and L. Pierard
Ischaemic mitral regurgitation: mechanisms and diagnosis
Heart,
October 15, 2009;
95(20):
1711 - 1718.
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Penicka, H. Linkova, O. Lang, R. Fojt, V. Kocka, M. Vanderheyden, and J. Bartunek
Predictors of Improvement of Unrepaired Moderate Ischemic Mitral Regurgitation in Patients Undergoing Elective Isolated Coronary Artery Bypass Graft Surgery
Circulation,
October 13, 2009;
120(15):
1474 - 1481.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
T. Abraham, D. Kass, G. Tonti, G. F. Tomassoni, W. T. Abraham, J. J. Bax, and T. H. Marwick
Imaging Cardiac Resynchronization Therapy
J. Am. Coll. Cardiol. Img.,
April 1, 2009;
2(4):
486 - 497.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Nazeri, A. Massumi, A. Rasekh, M. Saeed, C. Frank, J. M. Wilson, J. A. Lopez, and M. Razavi
Cardiac resynchronization therapy may improve symptoms of congestive heart failure in patients without electrical or mechanical dyssynchrony
Europace,
January 1, 2009;
11(1):
86 - 88.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Vahanian, B. Iung, L. Piérard, R. Dion, and J. Pepper
CHAPTER 21 Valvular Heart Disease
ESC Textbook of Cardiovascular Medicine,
January 1, 2009;
2(1):
med-9780199566990-chapter - med-9780199566990-chapter.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. Lancellotti, T. Marwick, and L. A Pierard
How to manage ischaemic mitral regurgitation
Heart,
November 1, 2008;
94(11):
1497 - 1502.
[Full Text]
[PDF]
|
|
|
|
|
|
|
F. I. Parthenakis, A. P. Patrianakos, E. N. Simantirakis, and P. E. Vardas
CRT and exercise capacity in heart failure: the impact of mitral valve regurgitation
Europace,
November 1, 2008;
10(suppl_3):
iii96 - iii100.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. O. Sweeney and F. W. Prinzen
Ventricular Pump Function and Pacing: Physiological and Clinical Integration
Circ Arrhythm Electrophysiol,
June 1, 2008;
1(2):
127 - 139.
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. E. Weyman
The Year in Echocardiography
J. Am. Coll. Cardiol.,
March 25, 2008;
51(12):
1221 - 1229.
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. Ypenburg, P. Lancellotti, L. F. Tops, E. Boersma, G. B. Bleeker, E. R. Holman, J. D. Thomas, M. J. Schalij, L. A. Pierard, and J. J. Bax
Mechanism of improvement in mitral regurgitation after cardiac resynchronization therapy
Eur. Heart J.,
March 2, 2008;
29(6):
757 - 765.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
