Abstract 13265: What Extent of Early Reverse Remodeling is Clinically Relevant After Restrictive Mitral Annuloplasty in Patients With Non-Ischemic Dilated Cardiomyopathy and Functional Mitral Regurgitation?
Objective: Restrictive mitral annuloplasty (RMA) can improve heart failure symptoms and induce left ventricular (LV) reverse remodeling in patients with non-ischemic dilated cardiomyopathy (DCM) and functional mitral regurgitation. However, it is unknown whether LV reverse remodeling translates into a better prognosis and what extent of early reverse remodeling is clinically relevant.
Method: Forty-sixe patients with advanced non-ischemic DCM (age, 63+/−9.1 years, 82% men) underwent RMA and were followed up with a mean of 2-year. Preoperatively, all had 3 to 4+ functional MR, an ejection fraction (EF) of 26 +/− 9.0 %, an indexed LV end-systolic volume (LVESVI) of 118 +/− 48 mL/m2. All patients received complete semi-rigid undersized ring annuloplasty. Correlation between early reduction in LVESVI at 1 month after the operation and long-term clinical outcomes were analyzed. The cutoff value for the extent of LV reverse remodeling in predicting late adverse outcomes was determined from the receiver operating characteristic (ROC) curve.
Result: There was no 30-day mortality. LVESVI significantly decreased to 97 +/− 56 mL/m2 and LVEF improved to 31 +/− 15% (p<0.05 for each). Change in LVESVI significantly correlated with improvement in LVEF (r=0.79, p<0.001). During follow-up, 14 (30%) recurred heart failure, of those 6 (13%) died. ROC curve found that a reduction in LVESVI more than 9% had a sensitivity of 79% and specificity of 78% in predicting all adverse events. With this cutoff value, there were 28 (61%) responders to reverse remodeling. Responders had significantly better survival (95.8% versus 71.4%, P=0.036), and freedom from heart failure rate (85.7% versus 20.3%, P=0.008) than non-responders at 4-year. On 1-year follow-up echocardiographic study, non-responders had still larger LVESVI (125 +/− 37 versus 46 +/− 9.0 mL/m2, P<0.0001), lower LVEF (22 +/− 9.2 versus 44 +/− 13 %, p=0.0002), and greater degree of MR (1.6 +/− 0.5 versus 0.9 +/− 0.7, p=0.02) than responders.
Conclusion: Early reduction in LVESVI more than 9% signifies clinically relevant reverse remodeling, which may predict mid-term mortality, heart failure events, and late reverse remodeling and repair durability.
- © 2010 by American Heart Association, Inc.