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(Circulation. 2005;112:I-437 – I-442.)
© 2005 American Heart Association, Inc.

Surgery for Valvular Heart Disease

MRI to Evaluate Left Atrial and Ventricular Reverse Remodeling After Restrictive Mitral Annuloplasty in Dilated Cardiomyopathy

Jos J.M. Westenberg, PhD; Rob J. van der Geest, MSc; Hildo J. Lamb, MD, PhD; Michel I.M. Versteegh, MD; Jerry Braun, MD; Joost Doornbos, PhD; Albert de Roos, MD, PhD; Ernst E. van der Wall, MD, PhD; Robert A.E. Dion, MD, PhD; Johan H.C. Reiber, PhD; Jeroen J. Bax, MD, PhD

From the Department of Radiology (J.J.M.W., R.J.v.d.G., J.H.C.R.), Division of Image Processing, Leiden University Medical Center, the Netherlands; Department of Radiology (H.J.L., J.D., A.d.R.), Leiden University Medical Center, the Netherlands; Department of Cardio-thoracic Surgery (M.I.M.V., J.B., R.A.E.D.), Leiden University Medical Center, the Netherlands; Department of Cardiology (E.E.v.d.W., J.J.B.), Leiden University Medical Center, the Netherlands.

Correspondence to Jos J. M. Westenberg, Division of Image Processing, Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands. E-mail j.j.m.westenberg{at}lumc.nl

Background— Data on reverse remodeling of the left atrium (LA) and left ventricle (LV) after restrictive annuloplasty in patients with dilated cardiomyopathy are scarce, and follow-up studies are performed with echocardiography.

Methods and Results— Twenty patients with dilated cardiomyopathy and severe mitral regurgitation selected for restrictive mitral annuloplasty underwent serial MRI studies (within 1 week before surgery, and 2 months [n =18] and 1 year [n =13] after surgery). Early mortality was 10%; all patients were free from endocarditis and thromboembolism. New York Heart Association class improved from 3.2±0.4 to 1.2±0.9. Only 1 patient developed recurrent severe mitral regurgitation during follow-up and it was re-repaired. LA end-systolic volumes decreased significantly over time (from 165±48 mL to 109±23 mL to 111±28 mL; P<0.01), as did LA end-diastolic volumes (from 92±32 mL to 71±22 mL to 75±17 mL; P=0.01). LV end-diastolic volumes decreased significantly (from 244±56 mL to 184±54 mL to 195±67 mL; P<0.01), whereas end-systolic volumes did not change significantly. LV ejection fraction increased significantly (from 35±8% to 46±13% to 46±15%; P<0.01) and LV mass decreased significantly (from 150±43 grams to 132±39 grams to 136±33 grams; P=0.02).

Conclusion— Restrictive annuloplasty in patients with dilated cardiomyopathy yielded excellent clinical results associated with significant LA and LV reverse remodeling over time as demonstrated by MRI.

Key Words: remodeling • mitral valve • magnetic resonance imaging • regurgitation • cardiac volume

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