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European Heart Journal Advance Access originally published online on February 27, 2008
European Heart Journal 2008 29(6):757-765; doi:10.1093/eurheartj/ehn063
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org

Mechanism of improvement in mitral regurgitation after cardiac resynchronization therapy

Claudia Ypenburg1, Patrizio Lancellotti2, Laurens F. Tops1, Eric Boersma3, Gabe B. Bleeker1, Eduard R. Holman1, James D. Thomas4, Martin J. Schalij1, Luc A. Piérard2 and Jeroen J. Bax1,*

1 Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
2 Department of Cardiology, University Hospital Sart Tilman, Liege, Belgium
3 Department of Epidemiology and Statistics, Erasmus University Rotterdam, Rotterdam, The Netherlands
4 Department of Cardiovascular Medicine, The Cleveland Clinic Foundation, Cleveland, OH, USA

Received 20 September 2007; revised 24 December 2007; accepted 24 January 2008; online publish-ahead-of-print 28 February 2008.

* Corresponding author. Tel: +31 71 526 2020, Fax: +31 71 526 6809, Email: j.j.bax{at}lumc.nl

Aims: The aim of the current study was to evaluate the relationship between the presence of left ventricular (LV) dyssynchrony at baseline and acute vs. late improvement in mitral regurgitation (MR) after cardiac resynchronization therapy (CRT).

Methods and results: Sixty eight patients consecutive (LV ejection fraction 23 ± 8%) with at least moderate MR (≥grade 2+) were included. Echocardiography was performed at baseline, 1 day after CRT initiation and at 6 months follow-up. Speckle tracking radial strain was used to assess LV dyssynchrony at baseline. The majority of patients improved in MR after CRT, with 43% improving immediately after CRT, and 20% improving late (after 6 months) after CRT. Early and late responders had similar extent of LV dyssynchrony (209 ± 115 ms vs. 190 ± 118 ms, P = NS); however, the site of latest activation in early responders was mostly inferior or posterior (adjacent to the posterior papillary muscle), whereas the lateral wall was the latest activated segment in late responders.

Conclusion: Current data suggest that the presence of baseline LV dyssynchrony is related to improvement in MR after CRT. LV dyssynchrony involving the posterior papillary muscle may lead to an immediate reduction in MR, whereas LV dyssynchrony in the lateral wall resulted in late response to CRT.

Key Words: Cardiac resynchronization therapy • Mitral valve regurgitation • LV dyssynchrony • Echocardiography • Heart failure


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