Europace Advance Access originally published online on June 15, 2007
Europace 2007 9(9):757-761; doi:10.1093/europace/eum122
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CARDIAC RESYNCHRONISATION THERAPY
Repercussion of functional mitral regurgitation on reverse remodelling in cardiac resynchronization therapy
Servicio de Cardiología, Hospital Universitario Virgen de la Victoria de Málaga, Campus de Teatinos s/n, Colonia Santa Ines, Malaga, Spain
Aims Cardiac resynchronization therapy (CRT) reduces the degree of functional mitral regurgitation (FMR). However, FMR has also been associated with a lack of clinical response to CRT. We undertook this study to determine whether the presence of FMR influences the reverse remodelling induced by CRT.
Methods and results We used Doppler echocardiography to assess 20 patients with dilated cardiomyopathy before and 6 months after undergoing CRT. We evaluated the effect of reverse remodelling (reduction 
10% in end-systolic volume) according to the presence or absence of important FMR, defined as a regurgitant orifice area (ROA) of 0.20 cm2. Of the 20 patients (mean age, 64.7 ± 8.2 years, eight women), 9 had marked FMR (ROA 0.40 ± 0.12 cm2), 6 mild FMR (ROA 0.15 ± 0.02 cm2), and 5 had trivial or no FMR. CRT reduced the presence of mitral regurgitation by 33.3% and induced reverse remodelling in 60% of the patients. A ROA 0.20 cm2 was associated with a lack of reverse remodelling, despite presenting similar baseline characteristics and a reduction in asynchrony to the other patients. Reverse remodelling was produced in all the other patients, with a significant reduction in end-systolic volume (41.7 ± 21%; P = 0.003), accompanied by improvement in the ejection fraction (P = 0.003) and myocardial performance index (P = 0.027).
Conclusion CRT improved FMR, although the baseline presence of important mitral regurgitation, with a ROA 0.20 cm2, in patients undergoing CRT was associated with a lack of response in reverse remodelling.
Key Words: Cardiac resynchronization, Reverse remodelling, Mitral regurgitation
* Corresponding author. Tel: +34 951031441; fax: +34 951032441. E-mail address: fjcabrera{at}secardiologia.es
Manuscript submitted 18 March 2007. Accepted after revision 17 May 2007.
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