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Hibino M, Dhingra NK, Chan V, Mazer CD, Teoh H, Quan A, Verma R, Leong-Poi H, Bisleri G, Connelly KA, Verma S. Stage-based approach to predict left ventricular reverse remodeling after mitral repair. Clin Cardiol 2022; 45:921-927. [PMID: 35748086 PMCID: PMC9451668 DOI: 10.1002/clc.23879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 05/31/2022] [Accepted: 06/08/2022] [Indexed: 11/17/2022] Open
Abstract
Background Although predictors of reverse left ventricular (LV) remodeling postmitral valve repair are critical for guiding perioperative decision‐making, there remains a paucity of randomized, prospective data to support the criteria that potential predictor variables must meet. Methods and Results The CAMRA CardioLink‐2 randomized trial allocated 104 patients to either leaflet resection or preservation strategies for mitral repair. The correlation of indexed left ventricular end‐systolic volume (LVESVI), indexed left ventricular end‐diastolic volume (LVEDVI), and left ventricular ejection fraction (LVEF) were tested with univariate analysis and subsequently with multivariate analysis to determine independent predictors of reverse remodeling at discharge and at 12 months postoperatively. At discharge, both LVESVI and LVEDVI were independently associated with their preoperative values (p < .001 for both) and LVEF by preoperative LVESVI (p < .001). Mitral ring size was favorably associated with the change in LVESVI (p < .05) and LVEF (p < .01) from predischarge to 12 months, while the mean mitral valve gradient after repair was adversely associated with the change in LVESVI (p < .05) and LVEDVI (p < .05). No significant associations were found between reverse remodeling and coaptation height nor mitral repair technique. Conclusions Beyond confirming the lack of impact of mitral repair technique on reverse remodeling, this investigation suggests that recommending surgery before significant LV dilatation or dysfunction, as well as higher postoperative mitral valve hemodynamic performance, may enhance remodeling capacity following mitral repair.
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Affiliation(s)
- Makoto Hibino
- Division of Cardiac Surgery, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Nitish K Dhingra
- Division of Cardiac Surgery, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Vincent Chan
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.,School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - C David Mazer
- Department of Anesthesia, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Physiology, University of Toronto, Toronto, Ontario, Canada
| | - Hwee Teoh
- Division of Cardiac Surgery, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada.,Division of Endocrinology and Metabolism, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
| | - Adrian Quan
- Division of Cardiac Surgery, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
| | - Raj Verma
- Royal College of Surgeon Ireland, Dublin, Ireland
| | - Howard Leong-Poi
- Division of Cardiology, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Gianluigi Bisleri
- Division of Cardiac Surgery, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Kim A Connelly
- Department of Physiology, University of Toronto, Toronto, Ontario, Canada.,Division of Cardiology, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Subodh Verma
- Division of Cardiac Surgery, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Division of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
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Constant Dit Beaufils AL, Huttin O, Jobbe-Duval A, Senage T, Filippetti L, Piriou N, Cueff C, Venner C, Mandry D, Sellal JM, Le Scouarnec S, Capoulade R, Marrec M, Thollet A, Beaumont M, Hossu G, Toquet C, Gourraud JB, Trochu JN, Warin-Fresse K, Marie PY, Schott JJ, Roussel JC, Serfaty JM, Selton-Suty C, Le Tourneau T. Replacement Myocardial Fibrosis in Patients With Mitral Valve Prolapse: Relation to Mitral Regurgitation, Ventricular Remodeling, and Arrhythmia. Circulation 2021; 143:1763-1774. [PMID: 33706538 DOI: 10.1161/circulationaha.120.050214] [Citation(s) in RCA: 80] [Impact Index Per Article: 26.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Mitral valve prolapse (MVP) is a frequent disease that can be complicated by mitral regurgitation (MR), heart failure, arterial embolism, rhythm disorders, and death. Left ventricular (LV) replacement myocardial fibrosis, a marker of maladaptive remodeling, has been described in patients with MVP, but the implications of this finding remain scarcely explored. We aimed at assessing the prevalence, pathophysiological and prognostic significance of LV replacement myocardial fibrosis through late gadolinium enhancement (LGE) by cardiac magnetic resonance in patients with MVP. METHODS Four hundred patients (53±15 years of age, 55% male) with MVP (trace to severe MR by echocardiography) from 2 centers, who underwent a comprehensive echocardiography and LGE cardiac magnetic resonance, were included. Correlates of replacement myocardial fibrosis (LGE+), influence of MR degree, and ventricular arrhythmia were assessed. The primary outcome was a composite of cardiovascular events (cardiac death, heart failure, new-onset atrial fibrillation, arterial embolism, and life-threatening ventricular arrhythmia). RESULTS Replacement myocardial fibrosis (LGE+) was observed in 110 patients (28%; 91 with myocardial wall including 71 with basal inferolateral wall, 29 with papillary muscle). LGE+ prevalence was 13% in trace-mild MR, 28% in moderate MR, and 37% in severe MR, and was associated with specific features of mitral valve apparatus, more dilated LV and more frequent ventricular arrhythmias (45% versus 26%, P<0.0001). In trace-mild MR, despite the absence of significant volume overload, abnormal LV dilatation was observed in 16% of patients and ventricular arrhythmia in 25%. Correlates of LGE+ in multivariable analysis were LV mass (odds ratio, 1.01 [95% CI, 1.002-1.017], P=0.009) and moderate-severe MR (odds ratio, 2.28 [95% CI, 1.21-4.31], P=0.011). LGE+ was associated with worse 4-year cardiovascular event-free survival (49.6±11.7 in LGE+ versus 73.3±6.5% in LGE-, P<0.0001). In a stepwise multivariable Cox model, MR volume and LGE+ (hazard ratio, 2.6 [1.4-4.9], P=0.002) were associated with poor outcome. CONCLUSIONS LV replacement myocardial fibrosis is frequent in patients with MVP; is associated with mitral valve apparatus alteration, more dilated LV, MR grade, and ventricular arrhythmia; and is independently associated with cardiovascular events. These findings suggest an MVP-related myocardial disease. Last, cardiac magnetic resonance provides additional information to echocardiography in MVP.
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Affiliation(s)
- Anne-Laure Constant Dit Beaufils
- Université de Nantes, CHU de Nantes, CNRS, INSERM, l'institut du thorax, France (A.-L.C.D.B., C.C., S.L.S., R.C., A.T., C.T., J.-B.G., J.-N.T., J.-J.S., J.-C.R., J.-M. Serfaty, T.L.T.)
| | - Olivier Huttin
- Service de Cardiologie, Institut Lorrain du Cœur et des Vaisseaux, CHU de Nancy, France (O.H., L.F., C.V., D.M., J.-M. Sellal, P.-Y.M., C.S.-S.)
| | - Antoine Jobbe-Duval
- CHU de Nantes, Université de Nantes, l'institut du thorax, CIC 1413, France (A.J.-D., T.S., N.P., C.C., M.M., A.T., C.T., J.-B.G., J.-N.T., K.W.-F., J.-C.R., J.-M. Serfaty, T.L.T.)
| | - Thomas Senage
- CHU de Nantes, Université de Nantes, l'institut du thorax, CIC 1413, France (A.J.-D., T.S., N.P., C.C., M.M., A.T., C.T., J.-B.G., J.-N.T., K.W.-F., J.-C.R., J.-M. Serfaty, T.L.T.).,Biostatistic Department, Université de Nantes, France (T.S.)
| | - Laura Filippetti
- Service de Cardiologie, Institut Lorrain du Cœur et des Vaisseaux, CHU de Nancy, France (O.H., L.F., C.V., D.M., J.-M. Sellal, P.-Y.M., C.S.-S.)
| | - Nicolas Piriou
- CHU de Nantes, Université de Nantes, l'institut du thorax, CIC 1413, France (A.J.-D., T.S., N.P., C.C., M.M., A.T., C.T., J.-B.G., J.-N.T., K.W.-F., J.-C.R., J.-M. Serfaty, T.L.T.)
| | - Caroline Cueff
- CHU de Nantes, Université de Nantes, l'institut du thorax, CIC 1413, France (A.J.-D., T.S., N.P., C.C., M.M., A.T., C.T., J.-B.G., J.-N.T., K.W.-F., J.-C.R., J.-M. Serfaty, T.L.T.).,Université de Nantes, CHU de Nantes, CNRS, INSERM, l'institut du thorax, France (A.-L.C.D.B., C.C., S.L.S., R.C., A.T., C.T., J.-B.G., J.-N.T., J.-J.S., J.-C.R., J.-M. Serfaty, T.L.T.)
| | - Clément Venner
- Service de Cardiologie, Institut Lorrain du Cœur et des Vaisseaux, CHU de Nancy, France (O.H., L.F., C.V., D.M., J.-M. Sellal, P.-Y.M., C.S.-S.)
| | - Damien Mandry
- Service de Cardiologie, Institut Lorrain du Cœur et des Vaisseaux, CHU de Nancy, France (O.H., L.F., C.V., D.M., J.-M. Sellal, P.-Y.M., C.S.-S.)
| | - Jean-Marc Sellal
- Service de Cardiologie, Institut Lorrain du Cœur et des Vaisseaux, CHU de Nancy, France (O.H., L.F., C.V., D.M., J.-M. Sellal, P.-Y.M., C.S.-S.)
| | - Solena Le Scouarnec
- Service de Cardiologie, Institut Lorrain du Cœur et des Vaisseaux, CHU de Nancy, France (O.H., L.F., C.V., D.M., J.-M. Sellal, P.-Y.M., C.S.-S.)
| | - Romain Capoulade
- Service de Cardiologie, Institut Lorrain du Cœur et des Vaisseaux, CHU de Nancy, France (O.H., L.F., C.V., D.M., J.-M. Sellal, P.-Y.M., C.S.-S.)
| | - Marie Marrec
- CHU de Nantes, Université de Nantes, l'institut du thorax, CIC 1413, France (A.J.-D., T.S., N.P., C.C., M.M., A.T., C.T., J.-B.G., J.-N.T., K.W.-F., J.-C.R., J.-M. Serfaty, T.L.T.)
| | - Aurélie Thollet
- CHU de Nantes, Université de Nantes, l'institut du thorax, CIC 1413, France (A.J.-D., T.S., N.P., C.C., M.M., A.T., C.T., J.-B.G., J.-N.T., K.W.-F., J.-C.R., J.-M. Serfaty, T.L.T.).,Service de Cardiologie, Institut Lorrain du Cœur et des Vaisseaux, CHU de Nancy, France (O.H., L.F., C.V., D.M., J.-M. Sellal, P.-Y.M., C.S.-S.)
| | | | - Gabriella Hossu
- CIC-IT, U1433, CHRU de Nancy, France; INSERM U1254, Imagerie Adaptative Diagnostique et Interventionnelle, Université de Lorraine, France (G.H.)
| | - Claire Toquet
- CHU de Nantes, Université de Nantes, l'institut du thorax, CIC 1413, France (A.J.-D., T.S., N.P., C.C., M.M., A.T., C.T., J.-B.G., J.-N.T., K.W.-F., J.-C.R., J.-M. Serfaty, T.L.T.).,Université de Nantes, CHU de Nantes, CNRS, INSERM, l'institut du thorax, France (A.-L.C.D.B., C.C., S.L.S., R.C., A.T., C.T., J.-B.G., J.-N.T., J.-J.S., J.-C.R., J.-M. Serfaty, T.L.T.)
| | - Jean-Baptiste Gourraud
- CHU de Nantes, Université de Nantes, l'institut du thorax, CIC 1413, France (A.J.-D., T.S., N.P., C.C., M.M., A.T., C.T., J.-B.G., J.-N.T., K.W.-F., J.-C.R., J.-M. Serfaty, T.L.T.).,Université de Nantes, CHU de Nantes, CNRS, INSERM, l'institut du thorax, France (A.-L.C.D.B., C.C., S.L.S., R.C., A.T., C.T., J.-B.G., J.-N.T., J.-J.S., J.-C.R., J.-M. Serfaty, T.L.T.)
| | - Jean-Noël Trochu
- CHU de Nantes, Université de Nantes, l'institut du thorax, CIC 1413, France (A.J.-D., T.S., N.P., C.C., M.M., A.T., C.T., J.-B.G., J.-N.T., K.W.-F., J.-C.R., J.-M. Serfaty, T.L.T.).,Université de Nantes, CHU de Nantes, CNRS, INSERM, l'institut du thorax, France (A.-L.C.D.B., C.C., S.L.S., R.C., A.T., C.T., J.-B.G., J.-N.T., J.-J.S., J.-C.R., J.-M. Serfaty, T.L.T.)
| | - Karine Warin-Fresse
- CHU de Nantes, Université de Nantes, l'institut du thorax, CIC 1413, France (A.J.-D., T.S., N.P., C.C., M.M., A.T., C.T., J.-B.G., J.-N.T., K.W.-F., J.-C.R., J.-M. Serfaty, T.L.T.)
| | - Pierre-Yves Marie
- Service de Cardiologie, Institut Lorrain du Cœur et des Vaisseaux, CHU de Nancy, France (O.H., L.F., C.V., D.M., J.-M. Sellal, P.-Y.M., C.S.-S.)
| | - Jean-Jacques Schott
- Université de Nantes, CHU de Nantes, CNRS, INSERM, l'institut du thorax, France (A.-L.C.D.B., C.C., S.L.S., R.C., A.T., C.T., J.-B.G., J.-N.T., J.-J.S., J.-C.R., J.-M. Serfaty, T.L.T.)
| | - Jean-Christian Roussel
- CHU de Nantes, Université de Nantes, l'institut du thorax, CIC 1413, France (A.J.-D., T.S., N.P., C.C., M.M., A.T., C.T., J.-B.G., J.-N.T., K.W.-F., J.-C.R., J.-M. Serfaty, T.L.T.).,Université de Nantes, CHU de Nantes, CNRS, INSERM, l'institut du thorax, France (A.-L.C.D.B., C.C., S.L.S., R.C., A.T., C.T., J.-B.G., J.-N.T., J.-J.S., J.-C.R., J.-M. Serfaty, T.L.T.)
| | - Jean-Michel Serfaty
- CHU de Nantes, Université de Nantes, l'institut du thorax, CIC 1413, France (A.J.-D., T.S., N.P., C.C., M.M., A.T., C.T., J.-B.G., J.-N.T., K.W.-F., J.-C.R., J.-M. Serfaty, T.L.T.).,Université de Nantes, CHU de Nantes, CNRS, INSERM, l'institut du thorax, France (A.-L.C.D.B., C.C., S.L.S., R.C., A.T., C.T., J.-B.G., J.-N.T., J.-J.S., J.-C.R., J.-M. Serfaty, T.L.T.)
| | - Christine Selton-Suty
- Service de Cardiologie, Institut Lorrain du Cœur et des Vaisseaux, CHU de Nancy, France (O.H., L.F., C.V., D.M., J.-M. Sellal, P.-Y.M., C.S.-S.)
| | - Thierry Le Tourneau
- CHU de Nantes, Université de Nantes, l'institut du thorax, CIC 1413, France (A.J.-D., T.S., N.P., C.C., M.M., A.T., C.T., J.-B.G., J.-N.T., K.W.-F., J.-C.R., J.-M. Serfaty, T.L.T.).,Université de Nantes, CHU de Nantes, CNRS, INSERM, l'institut du thorax, France (A.-L.C.D.B., C.C., S.L.S., R.C., A.T., C.T., J.-B.G., J.-N.T., J.-J.S., J.-C.R., J.-M. Serfaty, T.L.T.)
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