Abstract 3459: Geometric Improvement of Mitral Apparatus in Patients with Functional Mitral Regurgitation after Medical Treatment for Heart Failure
Background: Functional mitral regurgitation (MR), which is caused by mitral tenting secondary to left ventricular (LV) dysfunction, remarkably decreases after medical treatment for heart failure in some patients. However, geometric changes of mitral apparatus along with a decrease in MR have not been reported so far.
Methods: Among 265 consecutive patients with a record of severe MR by echocardiography, we reviewed 9 patients (age 60 ± 12 years, 6 men) who also showed mild MR after medical treatment and had neither structural mitral disease nor atrial fibrillation. We compared LV function and geometric parameters related to functional MR, such as tethering length, tenting height, tenting area and mitral annulus diameter between at the time of heart failure and after medical treatment.
Results: LV end-diastolic volume decreased and LV ejection fraction increased after medical treatment (LV end-diastolic volume: 205 ± 81 ml vs. 153 ± 62 ml; P=0.05, LV ejection fraction: 37.2 ± 12.9 % vs. 49.0 ± 17.1 %; P<0.05), and tethering length, tenting height, tenting area and mitral annulus diameter significantly decreased (tethering length: 4.81 ± 0.53 cm vs. 4.12 ± 0.54 cm; P<0.005, tenting height: 1.26 ± 0.24 cm vs. 0.82 ± 0.23 cm; p<0.01, tenting area: 2.57 ± 0.92 cm2 vs. 1.36 ± 0.48 cm2; p<0.01, mitral annulus diameter: 3.84 ± 0.37 cm vs. 3.19 ± 0.51 cm; p<0.005). There was no significant difference in systolic blood pressure (133 ± 32 mm Hg vs. 134 ± 28 mm Hg; NS).
Conclusions: Geometric improvement of mitral apparatus along with a decrease in MR after medical treatment for heart failure was confirmed. LV reversal remodeling by medical treatment could lead to a consequent improvement of mitral geometry.