Magnetic resonance imaging assessment of reverse left ventricular remodeling late after restrictive mitral annuloplasty in early stages of dilated cardiomyopathy.
OBJECTIVE
Magnetic resonance imaging was used to evaluate left ventricular reverse remodeling at long-term follow-up (3-4 years) after restrictive mitral annuloplasty in patients with early stages of nonischemic, dilated cardiomyopathy, and severe mitral regurgitation.


METHODS
Twenty-two selected patients (eligible to undergo magnetic resonance imaging) with mild to moderate heart failure (mean New York Heart Association class 2.2 +/- 0.4), dilated cardiomyopathy (left ventricular ejection fraction 37% +/- 5%, left ventricular end-diastolic volume 215 +/- 34 mL), and severe mitral regurgitation (grade 3-4+) underwent restrictive mitral annuloplasty. Magnetic resonance imaging was performed 1 week before surgery and repeated after 3 to 4 years.


RESULTS
There was no hospital mortality or major morbidity. Two patients died during follow-up (9%), and 2 patients could not undergo repeat magnetic resonance imaging because of comorbidity. New York Heart Association class improved from 2.2 +/- 0.4 to 1.2 +/- 0.4 (P < .05). Mitral regurgitation was minimal at late echocardiographic follow-up. There were significant decreases in indexed (to body surface area) left atrial end-systolic volume (from 84 +/- 20 mL/m(2) to 68 +/- 12 mL/m(2), P < .01), left ventricular end-systolic volume (from 42 +/- 14 mL/m(2) to 31 +/- 12 mL/m(2), P < .01), left ventricular end-diastolic volume (from 110 +/- 18 mL/m(2) to 80 +/- 17 mL/m(2), P < .01), and left ventricular mass (from 76 +/- 21 g/m(2) to 66 +/- 12 g/m(2), P = .03). Forward left ventricular ejection fraction improved from 37% +/- 5% to 55% +/- 10% (P < .01). Indexed left atrial end-diastolic volume did not show a significant decrease (from 48 +/- 16 mL/m(2) to 44 +/- 10 mL/m(2), P = .15).


CONCLUSIONS
Magnetic resonance imaging confirms sustained significant reverse left atrial and ventricular remodeling at late (3-4 years) follow-up in patients with nonischemic, dilated cardiomyopathy, and mild to moderate heart failure after restrictive mitral annuloplasty.
Department of Radiology, Division of Image Processing, Leiden University Medical Center, The Netherlands. j.j.m.westenberg@lumc.nl <E-mail:j.j.m.westenberg@lumc.nl>
Jos J M
JJ
Westenberg
Jerry
J
Braun
Nico R
NR
Van de Veire
Robert J M
RJ
Klautz
Michel I M
MI
Versteegh
Stijntje D
SD
Roes
Rob J
RJ
van der Geest
Albert
A
de Roos
Ernst E
EE
van der Wall
Johan H C
JH
Reiber
Jeroen J
JJ
Bax
Robert A E
RA
Dion
D000328:Adult; D000368:Aged; D006348:Cardiac Surgical Procedures / Q000379:methods*; D002311:Cardiomyopathy, Dilated / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D015331:Cohort Studies; D005069:Evaluation Studies as Topic; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000473:pathology / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D011182:Postoperative Care / Q000379:methods; D011300:Preoperative Care / Q000379:methods; D011336:Probability; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D020257:Ventricular Remodeling