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Chango Azanza DX, Munín MA, Raggio I, Perea G, Carbajales J. [Different phenotypes of mitral regurgitation in patients with right apical ventricular pacing: an echocardiographic approach in a heterogeneity of clinical scenarios]. ARCHIVOS PERUANOS DE CARDIOLOGIA Y CIRUGIA CARDIOVASCULAR 2021; 2:112-120. [PMID: 38274564 PMCID: PMC10809778 DOI: 10.47487/apcyccv.v2i2.130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 05/26/2021] [Indexed: 01/27/2024]
Abstract
The presence of mitral regurgitation (MR) in patients with right ventricular apical pacing can be the result of multiple phenomena. On the one hand, this stimulation causes an asynchronous activation of the left ventricle (LV) and the papillary muscles, leading to a deterioration of the LV ejection fraction and causing an inadequate closure of the valve apparatus. However, there is a wide heterogeneity of ischemic and non-ischemic myocardial conditions that can coexist with mechanical alteration of the LV and the mitral valve leading to or worsening MR in these patients, which can make the etiological determination of valvular regurgitation difficult. Transthoracic echocardiography study allows comprehensive evaluation of mitral valve regurgitation and ventricular function parameters and mechanical asynchrony as a result of artificial pacing. The comprehensive study of these phenomena is relevant in clinical decision-making to define those patients who benefit from cardiac resynchronization therapy to alleviate symptomatic MR.
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Affiliation(s)
- Diego Xavier Chango Azanza
- Departamento de Cardiología. Hospital General de Agudos «Ramos Mejía». Buenos Aires, Argentina. Departamento de CardiologíaHospital General de Agudos «Ramos MejíaBuenos AiresArgentina
| | - Martín Alejandro Munín
- Departamento de Ultrasonido Cardiovascular. Centro de Educación Médica e Investigaciones Clínicas «Norberto Quirno» CEMIC. Buenos Aires, Argentina.Departamento de Ultrasonido CardiovascularCentro de Educación Médica e Investigaciones Clínicas «Norberto Quirno» CEMICBuenos AiresArgentina
| | - Ignacio Raggio
- Departamento de Ultrasonido Cardiovascular. Centro de Educación Médica e Investigaciones Clínicas «Norberto Quirno» CEMIC. Buenos Aires, Argentina.Departamento de Ultrasonido CardiovascularCentro de Educación Médica e Investigaciones Clínicas «Norberto Quirno» CEMICBuenos AiresArgentina
| | - Gabriel Perea
- Departamento de Ultrasonido Cardiovascular. Centro de Educación Médica e Investigaciones Clínicas «Norberto Quirno» CEMIC. Buenos Aires, Argentina.Departamento de Ultrasonido CardiovascularCentro de Educación Médica e Investigaciones Clínicas «Norberto Quirno» CEMICBuenos AiresArgentina
| | - Justo Carbajales
- Departamento de Cardiología. Hospital General de Agudos «Ramos Mejía». Buenos Aires, Argentina. Departamento de CardiologíaHospital General de Agudos «Ramos MejíaBuenos AiresArgentina
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Lopes BBC, Kwon DH, Shah DJ, Lesser JR, Bapat V, Enriquez-Sarano M, Sorajja P, Cavalcante JL. Importance of Myocardial Fibrosis in Functional Mitral Regurgitation: From Outcomes to Decision-Making. JACC Cardiovasc Imaging 2021; 14:867-878. [PMID: 33582069 DOI: 10.1016/j.jcmg.2020.10.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 08/19/2020] [Accepted: 10/08/2020] [Indexed: 12/27/2022]
Abstract
Functional mitral regurgitation (FMR) is a common and complex valve disease, in which severity and risk stratification is still a conundrum. Although risk increases with FMR severity, it is modulated by subjacent left ventricular (LV) disease. The extent of LV remodeling and dysfunction is traditionally evaluated by echocardiography, but a growing body of evidence shows that myocardial fibrosis (MF) assessment by cardiac magnetic resonance (CMR) may complement risk stratification and inform treatment decisions. This review summarizes the current knowledge on the comprehensive evaluation that CMR can provide for patients with FMR, in particular for the assessment of MF and its potential impact in clinical decision-making.
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Affiliation(s)
- Bernardo B C Lopes
- Cardiovascular Imaging Research Center and Core Lab, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Deborah H Kwon
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Dipan J Shah
- Houston Methodist Debakey Heart & Vascular Center, Houston, Texas, USA
| | - John R Lesser
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA; Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Vinayak Bapat
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA; Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Maurice Enriquez-Sarano
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA; Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Paul Sorajja
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA; Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - João L Cavalcante
- Cardiovascular Imaging Research Center and Core Lab, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA; Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA; Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA.
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Mihos CG, Santana O, Yucel E, Capoulade R, Upadhyay GA, Orencole MP, Singh JP, Picard MH. The effects of cardiac resynchronization therapy on left ventricular and mitral valve geometry and secondary mitral regurgitation in patients with left bundle branch block. Echocardiography 2019; 36:1450-1458. [DOI: 10.1111/echo.14444] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Revised: 06/29/2019] [Accepted: 07/07/2019] [Indexed: 12/28/2022] Open
Affiliation(s)
- Christos G. Mihos
- Echocardiography Laboratory, Division of Cardiology, Mount Sinai Heart Institute Columbia University Miami Beach Florida
- Cardiac Ultrasound Laboratory Harvard Medical School Massachusetts General Hospital Boston Massachusetts
| | - Orlando Santana
- Echocardiography Laboratory, Division of Cardiology, Mount Sinai Heart Institute Columbia University Miami Beach Florida
| | - Evin Yucel
- Cardiac Ultrasound Laboratory Harvard Medical School Massachusetts General Hospital Boston Massachusetts
| | - Romain Capoulade
- Cardiac Ultrasound Laboratory Harvard Medical School Massachusetts General Hospital Boston Massachusetts
- Institut du Thorax, Inserm, CNRS Université de Nantes, CHU Nantes Nantes France
| | | | - Mary P. Orencole
- Cardiac Arrhythmia Service, Harvard Medical School Massachusetts General Hospital Boston Massachusetts
| | - Jagmeet P. Singh
- Cardiac Arrhythmia Service, Harvard Medical School Massachusetts General Hospital Boston Massachusetts
| | - Michael H. Picard
- Cardiac Ultrasound Laboratory Harvard Medical School Massachusetts General Hospital Boston Massachusetts
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