title: Predictors of mitral regurgitation recurrence in patients with heart failure undergoing mitral valve annuloplasty.
abstract: Restrictive mitral annuloplasty is a surgical treatment option for patients with heart failure (HF) and functional mitral regurgitation (MR). However, recurrent MR has been reported at mid-term follow-up. The aim of the present study was to identify the echocardiographic predictors of recurrent MR in patients with HF undergoing mitral annuloplasty. During a mean follow-up of 2.6 +/- 1.6 years, 109 patients with HF (49% ischemic and 51% idiopathic dilated cardiomyopathy) who had undergone mitral valve repair were followed up (of 122 total patients). The severity of MR was quantified, and the following parameters were measured before intervention and at the mid-term follow-up examination: left ventricular (LV) and left atrial volumes and dimensions, LV sphericity index, mitral annular area, and mitral valve geometry parameters. At mid-term follow-up, 21 patients presented with significant MR (grade 2 to 4), and 88 patients had only MR grade 0 to 1. Both groups of patients had had a similar preoperative MR grade, mitral annular area, and LV volume and dimension. In contrast, patients with recurrent MR had had increased preoperative posterior and anterior leaflet angles, tenting height, tenting area, and LV sphericity index compared to the patients without recurrent MR. Of the different parameters of mitral and LV geometry, the distal mitral anterior leaflet angle (hazard ratio 1.48, 95% confidence interval 1.32 to 1.66, p <0.001) and posterior leaflet angle (hazard ratio 1.13, 95% confidence interval 1.07 to 1.19, p <0.001) were independent determinants of MR at mid-term follow-up. In conclusion, in patients with HF of ischemic or idiopathic etiology and functional MR, distal mitral leaflet tethering and posterior mitral leaflet tethering were associated with recurrent MR after restrictive mitral annuloplasty.
authors.affiliation: Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Agnieszka
authors.initials: A
authors.lastname: Ciarka
authors.forename: Jerry
authors.initials: J
authors.lastname: Braun
authors.forename: Victoria
authors.initials: V
authors.lastname: Delgado
authors.forename: Michel
authors.initials: M
authors.lastname: Versteegh
authors.forename: Eric
authors.initials: E
authors.lastname: Boersma
authors.forename: Robert
authors.initials: R
authors.lastname: Klautz
authors.forename: Robert
authors.initials: R
authors.lastname: Dion
authors.forename: Jeroen J
authors.initials: JJ
authors.lastname: Bax
authors.forename: Nico
authors.initials: N
authors.lastname: Van de Veire
mesh_terms: D001026:Coronary Artery Bypass; D017548:Echocardiography, Transesophageal; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery*; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012008:Recurrence; D016896:Treatment Outcome