Abstract 12617: Decreased Mitral Valve Area During Exercise After Restrictive Mitral Annuloplasty in Functional Mitral Regurgitation is Associated With Absence of Left Ventricular Reverse Remodeling and Subsequent Worse Clinical Outcome
Introduction: Restrictive mitral annuloplasty (RMA) can provide a durable solution for functional mitral regurgitation (MR). Implantation of a downsized annuloplasty ring might however induce mitral stenosis at rest or, more pronounced, during exercise, with potential clinical impact.
Hypothesis: We evaluated the hypothesis that RMA does not induce a clinically relevant functional mitral stenosis during exercise.
Methods: Semi-supine bicycle exercise echocardiography was performed in 32 patients after RMA (ring sizes 24 or 26) for functional MR. Left ventricular volumes and ejection fraction, transmitral gradients and mitral valve area (MVA by VTI) were assessed at rest and during peak exercise and compared with preoperative echocardiographic data. Clinical events (all-cause mortality and hospital readmission for heart failure) were prospectively collected from the study visit until May 2015.
Results: Exercise echocardiography was performed 77 ± 35 months after RMA. In 25 patients MVA significantly increased during exercise (1.6 ± 0.4 to 2.0 ± 0.6 cm2, p <0.001), whereas MVA decreased in 7 patients (1.8 ± 0.5 to 1.5 ± 0.4 cm2, p <0.05). In patients with increased exercise MVA, LV end diastolic volumes at rest were reduced compared to preoperative echocardiographic data (190 ± 72 ml vs 144 ± 62 ml, p <0.01) with improved ejection fraction (36 ± 11 vs 40 ± 10 %, p <0.05). In contrast, in patients with decreased exercise MVA, LV reverse remodeling was absent (LVEDV 174 ± 54 ml preoperatively vs 189 ± 80 ml at rest; NS) and ejection fraction unchanged (37 ± 8 vs 33 ± 9 %, respectively; NS). Patients with decreased exercise MVA had worse event-free survival at 22 ± 6 months after the study visit (92 vs 57 %, p <0.05).
Conclusions: Hemodynamically significant mitral stenosis was not observed at rest nor during peak exercise after RMA. A decrease in MVA during exercise was related to absence of LV reverse remodeling between surgery and exercise echocardiography examination. Event-free survival was significantly worse in patients with decreased exercise MVA. In conclusion, not the insertion of a downsized mitral annuloplasty ring, but the absence of LV reverse remodeling is associated with the occurrence of decreased MVA during exercise and subsequent worse clinical outcome.
- Mitral regurgitation
- Stress echocardiography
- Cardiac surgery
- Ventricular remodeling
- Mitral valve disease
Author Disclosures: A.H. Petrus: None. J. Braun: None. L.F. Tops: None. E.R. Holman: None. N.A. Marsan: None. M.I. Versteegh: None. M.J. Schalij: None. J.J. Bax: None. R.J. Klautz: None.
- © 2015 by American Heart Association, Inc.