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Coronary Microvascular Dysfunction in Diabetes Mellitus: Pathogenetic Mechanisms and Potential Therapeutic Options. Biomedicines 2022; 10:biomedicines10092274. [PMID: 36140374 PMCID: PMC9496134 DOI: 10.3390/biomedicines10092274] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 09/04/2022] [Accepted: 09/09/2022] [Indexed: 11/16/2022] Open
Abstract
Diabetic patients are frequently affected by coronary microvascular dysfunction (CMD), a condition consisting of a combination of altered vasomotion and long-term structural change to coronary arterioles leading to impaired regulation of blood flow in response to changing cardiomyocyte oxygen requirements. The pathogenesis of this microvascular complication is complex and not completely known, involving several alterations among which hyperglycemia and insulin resistance play particularly central roles leading to oxidative stress, inflammatory activation and altered barrier function of endothelium. CMD significantly contributes to cardiac events such as angina or infarction without obstructive coronary artery disease, as well as heart failure, especially the phenotype associated with preserved ejection fraction, which greatly impact cardiovascular (CV) prognosis. To date, no treatments specifically target this vascular damage, but recent experimental studies and some clinical investigations have produced data in favor of potential beneficial effects on coronary micro vessels caused by two classes of glucose-lowering drugs: glucagon-like peptide 1 (GLP-1)-based therapy and inhibitors of sodium-glucose cotransporter-2 (SGLT2). The purpose of this review is to describe pathophysiological mechanisms, clinical manifestations of CMD with particular reference to diabetes, and to summarize the protective effects of antidiabetic drugs on the myocardial microvascular compartment.
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Early right ventricular reverse remodeling predicts survival after isolated tricuspid valve surgery. Ann Thorac Surg 2021; 112:1402-1409. [PMID: 33711306 DOI: 10.1016/j.athoracsur.2021.02.051] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 02/11/2021] [Accepted: 02/16/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND There are limited data on the impact of isolated tricuspid valve (TV) surgery on recovery of right ventricular (RV) function and RV reverse remodeling. METHODS Among 223 patients who had isolated TV procedures between 2001 and 2017, 60 (27%) underwent TV repair and 163 (73%) received TV replacement. Indication for surgery was functional TR in 64%, lead induced in 18%, and primary leaflet dysfunction in 18%. RV reverse remodeling was assessed by echocardiography at a median of 11.3 months (IQR 5.9-13.5) post-dismissal. RESULTS Mean age was 67.3±13.7 years, and 57% were female. Overall 30-day mortality was 2.7%. After a median follow-up period of 9.5 years (IQR 3.6-12.9), adjusted Cox regression analysis revealed comparable survival for TV repair and replacement and identified older age, and presence of RV dysfunction (HR 1.84, 95% CI 1.14-2.98; P=0.01) as independent predictors of poor survival. Patients who exhibited RV reverse remodeling within 18 months postoperatively had significantly improved survival compared to those who did not (Log-Rank P=0.005), and reverse remodeling was independently associated with improved survival (HR 0.42, 95% CI 0.24-0.74; P=0.003). Lower preoperative right atrial pressure (OR 0.83, 95% CI 0.73-0.94; P=0.004) was predictive of early RV reverse remodeling. CONCLUSIONS Isolated TV surgery can be performed with acceptable outcomes (early mortality 2.7%), and overall survival is best in patients who receive the operation before developing RV systolic dysfunction. Adjusted survival was similar for patients undergoing TV repair or replacement. Early reverse remodeling of RV after surgery is associated with survival benefit.
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Predictive Value of Pre-Operative 2D and 3D Transthoracic Echocardiography in Patients Undergoing Mitral Valve Repair: Long Term Follow Up of Mitral Valve Regurgitation Recurrence and Heart Chamber Remodeling. J Cardiovasc Dev Dis 2020; 7:jcdd7040046. [PMID: 33092178 PMCID: PMC7712008 DOI: 10.3390/jcdd7040046] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 10/19/2020] [Accepted: 10/20/2020] [Indexed: 01/30/2023] Open
Abstract
The “ideal” management of asymptomatic severe mitral regurgitation (MR) in valve prolapse (MVP) is still debated. The aims of this study were to identify pre-operatory parameters predictive of residual MR and of early and long-term favorable remodeling after MVP repair. We included 295 patients who underwent MV repair for MVP with pre-operatory two- and three-dimensional transthoracic echocardiography (2DTTE and 3DTTE) and 6-months (6M) and 3-years (3Y) follow-up 2DTTE. MVP was classified by 3DTTE as simple or complex and surgical procedures as simple or complex. Pre-operative echo parameters were compared to post-operative values at 6M and 3Y. Patients were divided into Group 1 (6M-MR < 2) and Group 2 (6M-MR ≥ 2), and predictors of MR ≥ 2 were investigated. MVP was simple in 178/295 pts, and 94% underwent simple procedures, while in only 42/117 (36%) of complex MVP a simple procedure was performed. A significant relation among prolapse anatomy, surgical procedures and residual MR was found. Post-operative MR ≥ 2 was present in 9.8%: complex MVP undergoing complex procedures had twice the percentage of MR ≥ 2 vs. simple MVP and simple procedures. MVP complexity resulted independent predictor of 6M-MR ≥ 2. Favorable cardiac remodeling, initially found in all cases, was maintained only in MR < 2 at 3Y. Pre-operative 3DTTE MVP morphology identifies pts undergoing simple or complex procedures predicting MR recurrence and favorable cardiac remodeling.
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Adingupu DD, Göpel SO, Grönros J, Behrendt M, Sotak M, Miliotis T, Dahlqvist U, Gan LM, Jönsson-Rylander AC. SGLT2 inhibition with empagliflozin improves coronary microvascular function and cardiac contractility in prediabetic ob/ob -/- mice. Cardiovasc Diabetol 2019; 18:16. [PMID: 30732594 PMCID: PMC6366096 DOI: 10.1186/s12933-019-0820-6] [Citation(s) in RCA: 112] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 01/28/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Sodium-glucose cotransporter 2 inhibitors (SGLT2i) is the first class of anti-diabetes treatment that reduces mortality and risk for hospitalization due to heart failure. In clinical studies it has been shown that SGLT2i's promote a general shift to fasting state metabolism characterized by reduced body weight and blood glucose, increase in glucagon/insulin ratio and modest increase in blood ketone levels. Therefore, we investigated the connection between metabolic changes and cardiovascular function in the ob/ob-/- mice; a rodent model of early diabetes with specific focus on coronary microvascular function. Due to leptin deficiency these mice develop metabolic syndrome/diabetes and hepatic steatosis. They also develop cardiac contractile and microvascular dysfunction and are thus a promising model for translational studies of cardiometabolic diseases. We investigated whether this mouse model responded in a human-like manner to empagliflozin treatment in terms of metabolic parameters and tested the hypothesis that it could exert direct effects on coronary microvascular function and contractile performance. METHODS Lean, ob/ob-/- untreated and ob/ob-/- treated with SGLT2i were followed for 10 weeks. Coronary flow velocity reserve (CFVR) and fractional area change (FAC) were monitored with non-invasive Doppler ultrasound imaging. Food intake, urinary glucose excursion and glucose control via HbA1c measurements were followed throughout the study. Liver steatosis was assessed by histology and metabolic parameters determined at the end of the study. RESULTS Sodium-glucose cotransporter 2 inhibitors treatment of ob/ob-/- animals resulted in a switch to a more catabolic state as observed in clinical studies: blood cholesterol and HbA1c were decreased whereas glucagon/insulin ratio and ketone levels were increased. SGLT2i treatment reduced liver triglyceride, steatosis and alanine aminotransferase, an indicator for liver dysfunction. L-Arginine/ADMA ratio, a marker for endothelial function was increased. SGLT2i treatment improved both cardiac contractile function and coronary microvascular function as indicated by improvement of FAC and CFVR, respectively. CONCLUSIONS Sodium-glucose cotransporter 2 inhibitors treatment of ob/ob-/- mice mimics major clinical findings regarding metabolism and cardiovascular improvements and is thus a useful translational model. We demonstrate that SGLT2 inhibition improves coronary microvascular function and contractile performance, two measures with strong predictive values in humans for CV outcome, alongside with the known metabolic changes in a preclinical model for prediabetes and heart failure.
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Affiliation(s)
- Damilola D. Adingupu
- Bioscience, Cardiovascular, Renal and Metabolic Diseases, IMED Biotech Unit, AstraZeneca Gothenburg, Pepparedsleden 1, Mölndal, 431 83 Gothenburg, Sweden
| | - Sven O. Göpel
- Bioscience, Cardiovascular, Renal and Metabolic Diseases, IMED Biotech Unit, AstraZeneca Gothenburg, Pepparedsleden 1, Mölndal, 431 83 Gothenburg, Sweden
| | - Julia Grönros
- Bioscience, Cardiovascular, Renal and Metabolic Diseases, IMED Biotech Unit, AstraZeneca Gothenburg, Pepparedsleden 1, Mölndal, 431 83 Gothenburg, Sweden
| | - Margareta Behrendt
- Bioscience, Cardiovascular, Renal and Metabolic Diseases, IMED Biotech Unit, AstraZeneca Gothenburg, Pepparedsleden 1, Mölndal, 431 83 Gothenburg, Sweden
| | - Matus Sotak
- Bioscience, Cardiovascular, Renal and Metabolic Diseases, IMED Biotech Unit, AstraZeneca Gothenburg, Pepparedsleden 1, Mölndal, 431 83 Gothenburg, Sweden
| | - Tasso Miliotis
- Translational Science, Cardiovascular, Renal and Metabolic Diseases, IMED Biotech Unit, AstraZeneca Gothenburg, Gothenburg, Sweden
| | - Ulrika Dahlqvist
- Bioscience, Cardiovascular, Renal and Metabolic Diseases, IMED Biotech Unit, AstraZeneca Gothenburg, Pepparedsleden 1, Mölndal, 431 83 Gothenburg, Sweden
| | - Li-Ming Gan
- Early Clinical Development, Cardiovascular, Renal and Metabolic Diseases, IMED Biotech Unit, AstraZeneca Gothenburg, Gothenburg, Sweden
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ann-Cathrine Jönsson-Rylander
- Bioscience, Cardiovascular, Renal and Metabolic Diseases, IMED Biotech Unit, AstraZeneca Gothenburg, Pepparedsleden 1, Mölndal, 431 83 Gothenburg, Sweden
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Brouwer HJ, Den Heijer MC, Paelinck BP, Debonnaire P, Vanderheyden M, Van De Heyning CM, De Bock D, Coussement P, Saad G, Ferdinande B, Pouleur AC, Claeys MJ. Left ventricular remodelling patterns after MitraClip implantation in patients with severe mitral valve regurgitation: mechanistic insights and prognostic implications. Eur Heart J Cardiovasc Imaging 2018; 20:307-313. [DOI: 10.1093/ehjci/jey088] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 06/03/2018] [Accepted: 06/07/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- Hiske J Brouwer
- Department of Cardiology, Antwerp University Hospital, Antwerpen, Wilrijkstraat 10, Edegem, Belgium
| | - Marc C Den Heijer
- Department of Cardiology, Antwerp University Hospital, Antwerpen, Wilrijkstraat 10, Edegem, Belgium
| | - Bernard P Paelinck
- Department of Cardiology, Antwerp University Hospital, Antwerpen, Wilrijkstraat 10, Edegem, Belgium
| | - Philippe Debonnaire
- Department of Cardiology, Hospital Sint-Jan Brugge, Ruddershove 10, Brugge, Belgium
| | - Marc Vanderheyden
- Department of Cardiology, Hospital OLV ziekenhuis, Moorselbaan 164, Aalst, Belgium
| | | | - Dina De Bock
- Department of Cardiology, Antwerp University Hospital, Antwerpen, Wilrijkstraat 10, Edegem, Belgium
| | - Patrick Coussement
- Department of Cardiology, Hospital Sint-Jan Brugge, Ruddershove 10, Brugge, Belgium
| | - Georges Saad
- Department of Cardiology, Centre Hospitalier Régional de la Citadelle, Boulevard du 12ème de Ligne, 1, Liège, Belgium
| | - Bert Ferdinande
- Department of Cardiology, Hospital Oost Limburg, Schiepse Bos 6, Genk, Belgium
| | - Anne-Catherine Pouleur
- Cardiovascular Department, Cliniques Universitaires Saint-Luc, & Institut de Recherche Expérimentale et Clinique (IREC), Université catholique de Louvain, Place de l'Université 1, Louvain-la-Neuve, Brussels, Belgium
| | - Marc J Claeys
- Department of Cardiology, Antwerp University Hospital, Antwerpen, Wilrijkstraat 10, Edegem, Belgium
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Murashita T, Schaff HV, Suri RM, Daly RC, Li Z, Dearani JA, Greason KL, Nishimura RA. Impact of Left Ventricular Systolic Function on Outcome of Correction of Chronic Severe Aortic Valve Regurgitation: Implications for Timing of Surgical Intervention. Ann Thorac Surg 2017; 103:1222-1228. [DOI: 10.1016/j.athoracsur.2016.09.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/11/2016] [Indexed: 10/20/2022]
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Suri RM, Schaff HV. Changes in left ventricular volume and decline in ejection fraction after degenerative mitral valve repair: The math makes sense. J Thorac Cardiovasc Surg 2015; 150:741-2. [PMID: 26319470 DOI: 10.1016/j.jtcvs.2015.06.075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 06/28/2015] [Indexed: 11/24/2022]
Affiliation(s)
- Rakesh M Suri
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Hartzell V Schaff
- Division of Thoracic and Cardiovascular Surgery, Mayo Clinic, Rochester, Minn
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Suri RM, Enriquez-Sarano M, Schaff HV. Preservation of left ventricular function after degenerative mitral valve repair: Refocusing on timing, techniques, and teaching. J Thorac Cardiovasc Surg 2015; 150:448-9. [PMID: 26319458 DOI: 10.1016/j.jtcvs.2015.07.046] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 07/14/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Rakesh M Suri
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, Cleveland, Ohio.
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Athanasopoulos LV, McGurk S, Khalpey Z, Rawn JD, Schmitto JD, Wollersheim LW, Maloney AM, Cohn LH. Usefulness of preoperative cardiac dimensions to predict success of reverse cardiac remodeling in patients undergoing repair for mitral valve prolapse. Am J Cardiol 2014; 113:1006-10. [PMID: 24444780 DOI: 10.1016/j.amjcard.2013.12.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Revised: 12/04/2013] [Accepted: 12/04/2013] [Indexed: 10/25/2022]
Abstract
Mitral valve repair for mitral regurgitation (MR) is currently recommended based on the degree of MR and left ventricular (LV) function. The present study examines predictors of reverse remodeling after repair for degenerative disease. We retrospectively identified 439 patients who underwent repair for myxomatous mitral valve degeneration and had both pre- and postoperative echocardiographic data available. Patients were categorized based on left atrial (LA) diameter and LV diameter standards of the American Society of Echocardiography. The outcome of interest was the degree of reverse remodeling on all heart dimensions at follow-up. Mean age was 57 ± 12 years, and 37% of patients were women. Mean preoperative LV end-diastolic diameter was 5.8 ± 0.7 cm, LV end-systolic diameter 3.5 ± 0.6 cm, LA 4.7 ± 0.7 cm, and median ejection fraction 60%. Median observation time was 81 months, and time to postoperative echocardiography was 38 months. Overall, 95% of patients had normal LV diastolic dimensions postoperatively, 93% normal LV systolic dimensions, and 37% normal LA dimensions. A Cox regression analysis showed that moderate (odds ratio [OR] 2.1, 95% confidence interval [CI] 1.3 to 3.4) or severe preoperative LA dilatation (OR 2.7, 95% CI 1.7 to 4.4), abnormal preoperative LV end-systolic dimensions (OR 1.3, 95% CI 1.1 to 1.5), and age in years (OR 1.02, 95% CI 1.01 to 1.03) were predictive of less reverse remodeling on follow-up. In conclusion, preoperative LV end-systolic dimensions and LA dilatation substantially affect the likelihood of successful LA remodeling and normalization of all heart dimensions after mitral valve repair for MR. These findings support early operation for MR before the increase in heart dimensions is nonreversible.
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Rudolph V, Moenig C, Lubos E, Lubs D, Knap M, Schlüter M, Kuß O, Koschyk D, Schwoerer AP, Treede H, Schirmer J, Reichenspurner H, Ehmke H, Blankenberg S, Baldus S. Baseline systolic left ventricular function determines hemodynamic adaptation following percutaneous mitral valve repair. Int J Cardiol 2013; 167:3039-40. [PMID: 23219314 DOI: 10.1016/j.ijcard.2012.11.093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2012] [Accepted: 11/11/2012] [Indexed: 11/19/2022]
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Foster E, Kwan D, Feldman T, Weissman NJ, Grayburn PA, Schwartz A, Rogers JH, Kar S, Rinaldi MJ, Fail PS, Hermiller J, Whitlow PL, Herrmann HC, Lim DS, Glower DD. Percutaneous Mitral Valve Repair in the Initial EVEREST Cohort. Circ Cardiovasc Imaging 2013; 6:522-30. [DOI: 10.1161/circimaging.112.000098] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Percutaneous repair of mitral regurgitation (MR) permits examination of the effect of MR reduction without surgery and cardiopulmonary bypass on left ventricular (LV) dimensions and function. The goal of this analysis was to determine the extent of reverse remodeling at 12 months after successful percutaneous reduction of MR with the MitraClip device.
Methods and Results—
Of 64 patients with 3 and 4+ MR who achieved acute procedural success after treatment with the MitraClip device, 49 patients had moderate or less MR at 12-month follow-up. Their baseline and 12-month echocardiograms were compared between the group with and without LV dysfunction. In patients with persistent MR reduction and pre-existing LV dysfunction, there was a reduction in LV wall stress, reduced LV end-diastolic volume, LV end-systolic volume and increase in LV ejection fraction in contrast to those with normal baseline LV function, who showed reduction in LV end-diastolic volume, LV wall stress, no change in LV end-systolic volume, and a fall in LV ejection fraction.
Conclusions—
Patients with pre-existing LV dysfunction demonstrate reverse remodeling and improved LV ejection fraction after percutaneous mitral valve repair.
Clinical Trial Registration—
URL:
http://www.clinicaltrials.gov
. Unique identifiers: NCT00209339, NCT00209274.
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Affiliation(s)
- Elyse Foster
- From the Division of Cardiology, University of California at San Francisco, CA (E.F.); Kaiser Permanente, Los Angeles, CA (D.K.); Evanston Hospital, NorthShore University Health System, Evanston, IL (T.F.); Mestar Health Research Institute at Washington Hospital Center and Georgetown University, DC (N.J.W.); Division of Cardiology, Department of Internal Medicine, Baylor University Medical Center, Dallas, TX (P.A.G.); Division of Cardiology, Department of Medicine, Columbia University Medical Center
| | - Damon Kwan
- From the Division of Cardiology, University of California at San Francisco, CA (E.F.); Kaiser Permanente, Los Angeles, CA (D.K.); Evanston Hospital, NorthShore University Health System, Evanston, IL (T.F.); Mestar Health Research Institute at Washington Hospital Center and Georgetown University, DC (N.J.W.); Division of Cardiology, Department of Internal Medicine, Baylor University Medical Center, Dallas, TX (P.A.G.); Division of Cardiology, Department of Medicine, Columbia University Medical Center
| | - Ted Feldman
- From the Division of Cardiology, University of California at San Francisco, CA (E.F.); Kaiser Permanente, Los Angeles, CA (D.K.); Evanston Hospital, NorthShore University Health System, Evanston, IL (T.F.); Mestar Health Research Institute at Washington Hospital Center and Georgetown University, DC (N.J.W.); Division of Cardiology, Department of Internal Medicine, Baylor University Medical Center, Dallas, TX (P.A.G.); Division of Cardiology, Department of Medicine, Columbia University Medical Center
| | - Neil J. Weissman
- From the Division of Cardiology, University of California at San Francisco, CA (E.F.); Kaiser Permanente, Los Angeles, CA (D.K.); Evanston Hospital, NorthShore University Health System, Evanston, IL (T.F.); Mestar Health Research Institute at Washington Hospital Center and Georgetown University, DC (N.J.W.); Division of Cardiology, Department of Internal Medicine, Baylor University Medical Center, Dallas, TX (P.A.G.); Division of Cardiology, Department of Medicine, Columbia University Medical Center
| | - Paul A. Grayburn
- From the Division of Cardiology, University of California at San Francisco, CA (E.F.); Kaiser Permanente, Los Angeles, CA (D.K.); Evanston Hospital, NorthShore University Health System, Evanston, IL (T.F.); Mestar Health Research Institute at Washington Hospital Center and Georgetown University, DC (N.J.W.); Division of Cardiology, Department of Internal Medicine, Baylor University Medical Center, Dallas, TX (P.A.G.); Division of Cardiology, Department of Medicine, Columbia University Medical Center
| | - Allan Schwartz
- From the Division of Cardiology, University of California at San Francisco, CA (E.F.); Kaiser Permanente, Los Angeles, CA (D.K.); Evanston Hospital, NorthShore University Health System, Evanston, IL (T.F.); Mestar Health Research Institute at Washington Hospital Center and Georgetown University, DC (N.J.W.); Division of Cardiology, Department of Internal Medicine, Baylor University Medical Center, Dallas, TX (P.A.G.); Division of Cardiology, Department of Medicine, Columbia University Medical Center
| | - Jason H. Rogers
- From the Division of Cardiology, University of California at San Francisco, CA (E.F.); Kaiser Permanente, Los Angeles, CA (D.K.); Evanston Hospital, NorthShore University Health System, Evanston, IL (T.F.); Mestar Health Research Institute at Washington Hospital Center and Georgetown University, DC (N.J.W.); Division of Cardiology, Department of Internal Medicine, Baylor University Medical Center, Dallas, TX (P.A.G.); Division of Cardiology, Department of Medicine, Columbia University Medical Center
| | - Saibal Kar
- From the Division of Cardiology, University of California at San Francisco, CA (E.F.); Kaiser Permanente, Los Angeles, CA (D.K.); Evanston Hospital, NorthShore University Health System, Evanston, IL (T.F.); Mestar Health Research Institute at Washington Hospital Center and Georgetown University, DC (N.J.W.); Division of Cardiology, Department of Internal Medicine, Baylor University Medical Center, Dallas, TX (P.A.G.); Division of Cardiology, Department of Medicine, Columbia University Medical Center
| | - Michael J. Rinaldi
- From the Division of Cardiology, University of California at San Francisco, CA (E.F.); Kaiser Permanente, Los Angeles, CA (D.K.); Evanston Hospital, NorthShore University Health System, Evanston, IL (T.F.); Mestar Health Research Institute at Washington Hospital Center and Georgetown University, DC (N.J.W.); Division of Cardiology, Department of Internal Medicine, Baylor University Medical Center, Dallas, TX (P.A.G.); Division of Cardiology, Department of Medicine, Columbia University Medical Center
| | - Peter S. Fail
- From the Division of Cardiology, University of California at San Francisco, CA (E.F.); Kaiser Permanente, Los Angeles, CA (D.K.); Evanston Hospital, NorthShore University Health System, Evanston, IL (T.F.); Mestar Health Research Institute at Washington Hospital Center and Georgetown University, DC (N.J.W.); Division of Cardiology, Department of Internal Medicine, Baylor University Medical Center, Dallas, TX (P.A.G.); Division of Cardiology, Department of Medicine, Columbia University Medical Center
| | - James Hermiller
- From the Division of Cardiology, University of California at San Francisco, CA (E.F.); Kaiser Permanente, Los Angeles, CA (D.K.); Evanston Hospital, NorthShore University Health System, Evanston, IL (T.F.); Mestar Health Research Institute at Washington Hospital Center and Georgetown University, DC (N.J.W.); Division of Cardiology, Department of Internal Medicine, Baylor University Medical Center, Dallas, TX (P.A.G.); Division of Cardiology, Department of Medicine, Columbia University Medical Center
| | - Patrick L. Whitlow
- From the Division of Cardiology, University of California at San Francisco, CA (E.F.); Kaiser Permanente, Los Angeles, CA (D.K.); Evanston Hospital, NorthShore University Health System, Evanston, IL (T.F.); Mestar Health Research Institute at Washington Hospital Center and Georgetown University, DC (N.J.W.); Division of Cardiology, Department of Internal Medicine, Baylor University Medical Center, Dallas, TX (P.A.G.); Division of Cardiology, Department of Medicine, Columbia University Medical Center
| | - Howard C. Herrmann
- From the Division of Cardiology, University of California at San Francisco, CA (E.F.); Kaiser Permanente, Los Angeles, CA (D.K.); Evanston Hospital, NorthShore University Health System, Evanston, IL (T.F.); Mestar Health Research Institute at Washington Hospital Center and Georgetown University, DC (N.J.W.); Division of Cardiology, Department of Internal Medicine, Baylor University Medical Center, Dallas, TX (P.A.G.); Division of Cardiology, Department of Medicine, Columbia University Medical Center
| | - D. Scott Lim
- From the Division of Cardiology, University of California at San Francisco, CA (E.F.); Kaiser Permanente, Los Angeles, CA (D.K.); Evanston Hospital, NorthShore University Health System, Evanston, IL (T.F.); Mestar Health Research Institute at Washington Hospital Center and Georgetown University, DC (N.J.W.); Division of Cardiology, Department of Internal Medicine, Baylor University Medical Center, Dallas, TX (P.A.G.); Division of Cardiology, Department of Medicine, Columbia University Medical Center
| | - Donald D. Glower
- From the Division of Cardiology, University of California at San Francisco, CA (E.F.); Kaiser Permanente, Los Angeles, CA (D.K.); Evanston Hospital, NorthShore University Health System, Evanston, IL (T.F.); Mestar Health Research Institute at Washington Hospital Center and Georgetown University, DC (N.J.W.); Division of Cardiology, Department of Internal Medicine, Baylor University Medical Center, Dallas, TX (P.A.G.); Division of Cardiology, Department of Medicine, Columbia University Medical Center
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Imasaka KI, Tomita Y, Tanoue Y, Tominaga R, Tayama E, Onitsuka H, Ueda T. Early mitral valve surgery for chronic severe mitral regurgitation optimizes left ventricular performance and left ventricular mass regression. J Thorac Cardiovasc Surg 2012; 146:61-6. [PMID: 22717277 DOI: 10.1016/j.jtcvs.2012.05.056] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2012] [Revised: 04/09/2012] [Accepted: 05/16/2012] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The optimal timing of mitral valve surgery for severe mitral regurgitation is controversial. We aimed to evaluate the changes in left ventricular performance using ventricular energetics and left ventricular mass regression after the surgery to determine the appropriate surgical timing in asymptomatic patients with severe mitral regurgitation. METHODS Fifty consecutive asymptomatic or minimally symptomatic patients who electively underwent the surgery for severe mitral regurgitation were studied retrospectively. Contractility (end-systolic elastance), afterload (effective arterial elastance), and efficiency (ventriculoarterial coupling and ratio of stroke work to pressure-volume area), and left ventricular mass index were measured echocardiographically before and 1 month after surgery. Two-way repeated-measures analysis of variance was used to compare the parameters between patients with (n = 17) and without (n = 33) left ventricular dysfunction (ie, ejection fraction ≤60% and/or end-systolic dimension ≥40 mm). RESULTS Contractility did not change significantly (P = .94) but the afterload increased significantly (P < .0001) in both groups. Consequently, the efficiency deteriorated significantly (ventriculoarterial coupling, P = .0004; ratio of stroke work to pressure-volume area, P < .0001). Furthermore, the left ventricular mass index improved remarkably in both groups (P < .0001). Alternatively, the patients with normal left ventricular function had greater contractility (P < .0001), less worsened efficiency (P < .0001 and P < .0001, respectively), and a better left ventricular mass index (P = .0002) after surgery. CONCLUSIONS Early surgery for severe mitral regurgitation preserves left ventricular performance and improves left ventricular mass regression in asymptomatic patients with normal ventricular function.
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Affiliation(s)
- Ken-ichi Imasaka
- Department of Cardiovascular Surgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
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Caiani EG, Fusini L, Veronesi F, Tamborini G, Maffessanti F, Gripari P, Corsi C, Naliato M, Zanobini M, Alamanni F, Pepi M. Quantification of mitral annulus dynamic morphology in patients with mitral valve prolapse undergoing repair and annuloplasty during a 6-month follow-up. EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY 2011; 12:375-83. [DOI: 10.1093/ejechocard/jer016] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Stulak JM, Suri RM, Dearani JA, Burkhart HM, Sundt TM, Enriquez-Sarano M, Schaff HV. Does early surgical intervention improve left ventricular mass regression after mitral valve repair for leaflet prolapse? J Thorac Cardiovasc Surg 2011; 141:122-9. [DOI: 10.1016/j.jtcvs.2010.08.068] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2010] [Revised: 07/20/2010] [Accepted: 08/15/2010] [Indexed: 10/18/2022]
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