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Chew PG, Dobson LE, Garg P, Richards FJL, Foley JR, Fent GJ, Brown LAE, Saunderson CED, Das A, Kidambi A, Levelt E, Swoboda PP, Dall'armellina E, Plein S, Greenwood JP. P589Assessment of cardiac reverse remodelling following mitral valve repair and mitral valve replacement in degenerative mitral regurgitation: a cardiovascular magnetic resonance study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Mitral valve (MV) repair is currently recommended over replacement (1). The guidelines suggesting this are however based on historic evidence which compared outdated techniques of MV replacement. Recent data cast doubts on its validity in the current era of chordal-preservation techniques in MV replacement.
Purpose
Using cardiovascular magnetic resonance (CMR) imaging, this study aimed to assess the impact of MV repair and MV replacement on cardiac left ventricular (LV) reverse remodelling.
Methods
65 patients with moderate-severe and severe mitral regurgitation (MR) were prospectively recruited. Of these, 37 patients (59% men, 65±15 years) to date with paired CMR scans at baseline and at 6 months were evaluated. Patients either underwent MV repair (n=9), MV replacement (n=10) or watchful waiting (n=18). The CMR protocol included cines for left ventricle (LV), left atria (LA), and aortic flow assessment. The LA and LV parameters, and MR fraction were analysed.
Results
At 6 months, both the MV repair and replacement groups exhibited a reduction in LV end-diastolic volume (LVEDV) and LA volumes when compared to the control group. The indexed LVEDV decreased significantly from 129±33ml/m2 to 99±37ml/m2, p<0.001 in the repair group, from 118±24ml/m2 to 90±26ml/m2, p<0.001 in the replacement group and remained unchanged in the control group 115±25ml/m2 to 113±25ml/m2, p=0.53. The absolute reduction in indexed LVEDV was not significantly different between the repair and replacement groups (−30±15ml/m2 vs −29±19ml/m2, repair vs replacement, p=1.00). Similarly, both surgical groups also sustained an equal degree of LA size reduction (−42±26ml/m2 vs −36±23ml/m2, repair vs replacement; p=1.00). There was a decline in the global postoperative LV ejection fraction (Table 1). The degree of reduction in LV ejection fraction however did not differ between the repair and replacement group (−9±6% vs −6±8%, repair vs replacement; p=1.00). Those undergoing surgery experienced a significant reduction in their MR severity, although those with replacement had a more effective reduction in MR severity (MR fraction for repair: 47±9% to 15±10%, p<0.001 vs replacement: 41±13% to 5±4%, p<0.001).
Conclusion
MV surgery leads to atrial and left ventricular reverse remodelling, and a decline in global LV ejection fraction. In this small series, MV replacement with chordal preservation showed similar cardiac reverse remodelling benefits to MV repair. Although residual MR is often seen following repair, this did not lead to less favourable cardiac reverse remodelling.
Acknowledgement/Funding
Leeds NIHR infrastructure
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Affiliation(s)
- P G Chew
- University of Leeds, Leeds, United Kingdom
| | - L E Dobson
- University of Leeds, Leeds, United Kingdom
| | - P Garg
- University of Leeds, Leeds, United Kingdom
| | | | - J R Foley
- University of Leeds, Leeds, United Kingdom
| | - G J Fent
- University of Leeds, Leeds, United Kingdom
| | | | | | - A Das
- University of Leeds, Leeds, United Kingdom
| | - A Kidambi
- University of Leeds, Leeds, United Kingdom
| | - E Levelt
- University of Leeds, Leeds, United Kingdom
| | | | | | - S Plein
- University of Leeds, Leeds, United Kingdom
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2
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Brown L, Saunderson CED, Das A, Craven T, Xue H, Knott K, Levelt E, Dall"armellina E, Swoboda PP, Moon J, Greenwood JP, Kellman P, Plein S. P152Assessing myocardial perfusion in heart failure - are we achieving adequate stress? Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez117.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- L Brown
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - C E D Saunderson
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - A Das
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - T Craven
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - H Xue
- National Institutes of Health, Bethesda, United States of America
| | - K Knott
- Barts Health NHS Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - E Levelt
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - E Dall"armellina
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - P P Swoboda
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - J Moon
- Barts Health NHS Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - J P Greenwood
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - P Kellman
- National Institutes of Health, Bethesda, United States of America
| | - S Plein
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
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Brown L, Saunderson CED, Das A, Craven T, Xue H, Knott K, Levelt E, Moon J, Dall"armellina E, Greenwood JP, Kellman P, Plein S, Swoboda PP. P151Defining the phenotype of heart failure with mid-range ejection fraction by cardiovascular magnetic resonance. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez117.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- L Brown
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - C E D Saunderson
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - A Das
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - T Craven
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - H Xue
- National Institutes of Health, Bethesda, United States of America
| | - K Knott
- Barts Health NHS Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - E Levelt
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - J Moon
- Barts Health NHS Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - E Dall"armellina
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - J P Greenwood
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - P Kellman
- National Institutes of Health, Bethesda, United States of America
| | - S Plein
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - P P Swoboda
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
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Das A, Kelly C, Teh I, Stoeck CT, Kozerke S, Brown LAE, Saunderson CED, Craven T, Swoboda PP, Levelt E, Greenwood JP, Plein S, Schneider JE, Dallarmellina E. 542Longitudinal changes in diffusion tensor imaging parameters following acute ST-elevation myocardial infarction. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- A Das
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - C Kelly
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - I Teh
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - C T Stoeck
- University of Zurich, Institute of Biomedical Engineering, Zurich, Switzerland
| | - S Kozerke
- University of Zurich, Institute of Biomedical Engineering, Zurich, Switzerland
| | - L A E Brown
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - C E D Saunderson
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - T Craven
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - P P Swoboda
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - E Levelt
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - J P Greenwood
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - S Plein
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - J E Schneider
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - E Dallarmellina
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
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Craven T, Levelt E, Jex N, Jain M, Brown LAE, Saunderson CED, Das A, Dall" Armellina E, Bijsterveld P, Greenwood JP, Plein S, Swoboda PP. P153Modulation of renin-angiotensin-aldosterone system reverses adverse left atrial remodelling in type 2 diabetes. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez117.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- T Craven
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - E Levelt
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - N Jex
- Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - M Jain
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - L A E Brown
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - C E D Saunderson
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - A Das
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - E Dall" Armellina
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - P Bijsterveld
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - J P Greenwood
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - S Plein
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - P P Swoboda
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
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Hickman SE, Saunderson CED, Wilkinson E, Tayebjee MH. 116Survey to evaluate awareness and current practice of venous thromboembolism prevention following electrophysiological procedures in the United Kingdom. Europace 2017. [DOI: 10.1093/europace/eux283.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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