title: Clinical and functional effects of restrictive mitral annuloplasty at midterm follow-up in heart failure patients.
abstract: BACKGROUND
  Restrictive mitral annuloplasty (RMA) is increasingly applied to treat functional mitral regurgitation in heart failure patients. Previous studies indicated beneficial clinical effects with low recurrence rates. However, the underlying pathophysiology is complex and outcome in terms of left ventricular function is not well known. We investigated chronic effects of RMA on ventricular function in relation to clinical outcome.
  
  
  METHODS
  Heart failure patients (n = 11) with severe mitral regurgitation scheduled for RMA were analyzed at baseline (presurgery) and midterm follow-up by invasive pressure-volume loops, using conductance catheters. Clinical performance was evaluated by New York Heart Association class, quality-of-life-score, and 6-minute hall-walk-test.
  
  
  RESULTS
  All patients were alive without recurrence of mitral regurgitation at follow-up (9.4 ± 4.1 months). Clinical parameters improved significantly (all p < 0.05). Global cardiac function, assessed by cardiac output, stroke volume, and stroke work did not change after RMA. Reverse remodeling was demonstrated by decreased end-systolic and end-diastolic volumes (16% and 11%, both p < 0.001). Systolic function improved, evidenced by increased ejection fraction (0.32 ± 0.05 to 0.36 ± 0.07, p = 0.001) and leftward shift of the end-systolic pressure-volume relation (ESV(100): 116 ± 43 to 74 ± 26 mL, p < 0.001). Diastolic function, however, demonstrated impairment by increased tau (69 ± 13 to 80 ± 14 ms, p < 0.001) and stiffness constant (0.022 ± 0.022 to 0.031 ± 0.028 mL(-1), p = 0.001).
  
  
  CONCLUSIONS
  Restrictive mitral annuloplasty significantly improved clinical status without recurrence of mitral regurgitation at midterm follow-up in patients with heart failure. Hemodynamic analyses demonstrated significant reverse remodeling with unchanged global function and improved systolic function, but some signs of diastolic impairment. Overall, RMA appears an appropriate therapy for patients with dilated cardiomyopathy and functional mitral regurgitation.
authors.affiliation: Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Ellen A
authors.initials: EA
authors.lastname: ten Brinke
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Klautz
authors.forename: Sven A
authors.initials: SA
authors.lastname: Tulner
authors.forename: Harriette F
authors.initials: HF
authors.lastname: Verwey
authors.forename: Jeroen J
authors.initials: JJ
authors.lastname: Bax
authors.forename: Victoria
authors.initials: V
authors.lastname: Delgado
authors.forename: Eduard R
authors.initials: ER
authors.lastname: Holman
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Schalij
authors.forename: Ernst E
authors.initials: EE
authors.lastname: van der Wall
authors.forename: Jerry
authors.initials: J
authors.lastname: Braun
authors.forename: Michel I
authors.initials: MI
authors.lastname: Versteegh
authors.forename: Robert A
authors.initials: RA
authors.lastname: Dion
authors.forename: Paul
authors.initials: P
authors.lastname: Steendijk
mesh_terms: D000368:Aged; D058385:Cardiac Valve Annuloplasty / Q000379:methods*; D018618:Echocardiography, Doppler, Color; D017548:Echocardiography, Transesophageal; D005080:Exercise Test; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000150:complications / Q000401:mortality / Q000601:surgery*; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D008297:Male; D008944:Mitral Valve Insufficiency / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D011788:Quality of Life; D013318:Stroke Volume / Q000502:physiology*; D013997:Time Factors; D016896:Treatment Outcome