title: Role of cardiac dyssynchrony and resynchronization therapy in functional mitral regurgitation.
abstract: Functional mitral regurgitation (FMR) is a common complication of left ventricle (LV) dysfunction and remodelling. Recently, it has been recognized as an independent prognostic factor in both ischaemic and non-ischaemic LV dysfunctions. In this review article, we discuss the mechanisms through which cardiac dyssynchrony is involved in FMR pathophysiologic cascade and how cardiac resynchronization therapy (CRT) can have therapeutic effects on FMR by reverting specific dyssynchrony pathways. We analyse recent clinical trials focusing on CRT impact on FMR in 'real-world' patients, the limits and future perspectives that could eventually generate new predictors of CRT response in terms of FMR reduction. Finally, we propose a practical diagnostic and therapeutic strategy for the management of symptomatic patients with severe LV dysfunction and concomitant 'prognostic' FMR.
authors.affiliation: Division of Cardiology, Cardiovascular Department, San Raffaele Hospital, IRCCS, Via Olgettina 60, Milan 20132, Italy marco.spartera@gmail.com.
authors.forename: Marco
authors.initials: M
authors.lastname: Spartera
authors.affiliation: Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Galderisi
authors.affiliation: Department of Cardiology, University of Ferrara, Ferrara, Italy.
authors.forename: Donato
authors.initials: D
authors.lastname: Mele
authors.affiliation: Department of Cardiovascular Diseases, University of Siena, Siena, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Cameli
authors.affiliation: Department of Cardiology, Second University of Naples, Monaldi Hospital, "dei Colli-Monaldi" Hospitals, Naples, Italy.
authors.forename: Antonello
authors.initials: A
authors.lastname: D'Andrea
authors.affiliation: Department of Medicine, Section of Cardiology, University of Verona, Verona, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Rossi
authors.affiliation: Department of Cardiovascular Diseases, University of Siena, Siena, Italy.
authors.forename: Sergio
authors.initials: S
authors.lastname: Mondillo
authors.affiliation: Department of Cardiology, University Hospital "Paolo Giaccone", Palermo, Italy.
authors.forename: Giuseppina
authors.initials: G
authors.lastname: Novo
authors.affiliation: Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy.
authors.forename: Roberta
authors.initials: R
authors.lastname: Esposito
authors.affiliation: Department of Cardiovascular Diseases, University of Siena, Siena, Italy.
authors.forename: Flavio
authors.initials: F
authors.lastname: D'Ascenzi
authors.affiliation: Clinical Cardiology, University of Cagliari, Cagliari, Italy.
authors.forename: Roberta
authors.initials: R
authors.lastname: Montisci
authors.affiliation: Division of Cardiology G. D'Annunzio University, S. Camillo de Lellis Hospital, Chieti, Italy.
authors.forename: Sabina
authors.initials: S
authors.lastname: Gallina
authors.affiliation: Division of Cardiology, Cardiovascular Department, San Raffaele Hospital, IRCCS, Via Olgettina 60, Milan 20132, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Margonato
authors.affiliation: Division of Cardiology, Cardiovascular Department, San Raffaele Hospital, IRCCS, Via Olgettina 60, Milan 20132, Italy.
authors.forename: Eustachio
authors.initials: E
authors.lastname: Agricola
mesh_terms: D002304:Cardiac Pacing, Artificial; D058406:Cardiac Resynchronization Therapy / Q000379:methods; D002986:Clinical Trials as Topic; D018618:Echocardiography, Doppler, Color / Q000379:methods*; D006801:Humans; D008944:Mitral Valve Insufficiency / Q000175:diagnosis / Q000503:physiopathology* / Q000628:therapy; D010138:Pacemaker, Artificial; D011379:Prognosis; D013318:Stroke Volume; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000503:physiopathology* / Q000628:therapy; D016277:Ventricular Function, Left; D020257:Ventricular Remodeling
keywords: cardiac resynchronization; mitral regurgitation; ventricular dyssynchrony