Mitral valve repair for secondary mitral regurgitation in non-ischaemic dilated cardiomyopathy is associated with left ventricular reverse remodelling and increase of forward flow.
It remains unclear whether surgical or transcatheter mitral valve repair for secondary mitral regurgitation (MR) in patients with non-ischaemic cardiomyopathy reverse the underlying left ventricular (LV) pathophysiology. We hypothesized that mitral valve repair improves LV systolic function and forward flow and induces LV reverse remodelling in this group of patients.



Seventy-six patients (65 ± 14 years old, 43% male) with non-ischaemic cardiomyopathy and moderate to severe chronic secondary MR treated successfully with transcatheter or surgical mitral valve repair were evaluated. Transthoracic echocardiography was performed at baseline, discharge and 6 months post-repair. After mitral valve repair, LVEF, and LV global longitudinal strain (GLS) corrected for LV end-diastolic volume remained unchanged over time (P = 0.90 and P = 0.96, respectively). In contrast, LV forward flow increased significantly over time (stroke volume index: from 20 ± 7 to 29 ± 8 and 26 ± 8 mL/m2, P < 0.001; cardiac index: from 1.50 ± 0.44 to 2.36 ± 0.60 and 2.01 ± 0.48 L/min/m2, P < 0.001). In addition, LV end-diastolic and end-systolic volume index significantly reduced over time (from 87 ± 42 to 70 ± 33 and 75 ± 39 mL/m2, P < 0.001; and from 60 ± 35 to 50 ± 30 and 53 ± 36 mL/m2, P = 0.004, respectively). These changes were independent of the type of repair.



Surgical and transcatheter mitral valve repair for secondary MR in patients with non-ischaemic dilated cardiomyopathy improved LV forward flow and induced LV reverse remodelling but did not change LV systolic function.
Department of Cardiology, Heart Lung Centre, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, 9600, 2300 RC Leiden, The Netherlands.|Department of Cardiology, AHEPA University Hospital, Stilponos Kyriakidi Street 1, P.O. 54636, Thessaloniki, Greece.
Vasileios
V
Kamperidis
Department of Cardiology, Heart Lung Centre, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, 9600, 2300 RC Leiden, The Netherlands.
Suzanne E
SE
van Wijngaarden
Department of Cardiology, Heart Lung Centre, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, 9600, 2300 RC Leiden, The Netherlands.
Philippe J
PJ
van Rosendael
Department of Cardiology, Heart Lung Centre, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, 9600, 2300 RC Leiden, The Netherlands.|Department of Cardiology, National University Heart Centre, National University Health System, 5 Lower Kent Ridge Road, Singapore 119074 Singapore.
William Kok Fai
WKF
Kong
Department of Cardiology, Heart Lung Centre, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, 9600, 2300 RC Leiden, The Netherlands.
Madelien V
MV
Regeer
Department of Cardiology, Heart Lung Centre, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, 9600, 2300 RC Leiden, The Netherlands.
Frank
F
van der Kley
Department of Cardiology, AHEPA University Hospital, Stilponos Kyriakidi Street 1, P.O. 54636, Thessaloniki, Greece.
Georgios
G
Sianos
Department of Cardiology, Heart Lung Centre, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, 9600, 2300 RC Leiden, The Netherlands.
Nina
N
Ajmone Marsan
Department of Cardiology, Heart Lung Centre, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, 9600, 2300 RC Leiden, The Netherlands.
Jeroen J
JJ
Bax
Department of Cardiology, Heart Lung Centre, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, 9600, 2300 RC Leiden, The Netherlands.
Victoria
V
Delgado
D000368:Aged; D006328:Cardiac Catheterization / Q000379:methods; D058385:Cardiac Valve Annuloplasty / Q000379:methods*; D002311:Cardiomyopathy, Dilated / Q000000981:diagnostic imaging / Q000453:epidemiology*; D015331:Cohort Studies; D015897:Comorbidity; D004452:Echocardiography / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000601:surgery*; D012189:Retrospective Studies; D018570:Risk Assessment; D013318:Stroke Volume / Q000502:physiology; D016896:Treatment Outcome; D020257:Ventricular Remodeling / Q000502:physiology*
dilated cardiomyopathy; mitraclip; secondary mitral regurgitation; speckle tracking echocardiography; surgical mitral valve repair