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Published on: December 11, 2017
Geometric Changes in Mitral Valve Apparatus during Long-term Cardiac Resynchronization Therapy as Assessed with
Daniel B Fyenbo1, Bjarne L Nørgaard1, Philipp Blanke1
1From the Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark (D.B.F., B.L.N., M.B.K., J.M.J., J.C.N.); Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark (D.B.F., B.L.N., M.B.K., J.C.N.); Medical Diagnostic Center, Silkeborg and Viborg Regional Hospital, Denmark (D.B.F.); Department of Medical Imaging, St Paul's Hospital, Vancouver, Canada (P.B., J.D., K.K., J.L.); University of British Columbia, Vancouver, Canada (P.B., J.L.); Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark (A.S.); Department of Bioengineering, UC San Diego School of Engineering, La Jolla, Calif (E.R.M.); Departments of Radiology and Cardiology, UC San Diego School of Medicine, La Jolla, Calif (E.R.M.); Heart Institute, University Hospital Germans Trias i Pujol, Badalona, Spain (V.D.); and Centre of Comparative Medicine and Bioimaging (CMCIB), Badalona, Spain (V.D.).
Insights
Long-term cardiac resynchronization therapy (CRT) reduced mitral valve apparatus dimensions, specifically interpapillary muscle distances, which correlated with improved left ventricular volumes. Other geometric changes did not show significant correlations.
Area of Science:
- Cardiovascular Imaging and Intervention
- Cardiac Electrophysiology
Background:
- Cardiac resynchronization therapy (CRT) is used to treat heart failure patients with electrical dyssynchrony.
- Long-term effects of CRT on the mitral valve apparatus geometry are not fully understood.
Purpose of the Study:
- To evaluate long-term geometric alterations of the mitral valve apparatus after CRT using cardiac CT.
- To assess the correlation between these geometric changes and left ventricular (LV) volumes and function.
Main Methods:
- Prospective follow-up cardiac CT examinations in participants of a randomized controlled trial (NCT01323686).
- Assessment of mitral valve annulus area, A2 leaflet angle, tenting height, and interpapillary muscle distances.
- Correlation analysis between geometric changes and LV volumes/function using Pearson correlation test.
Main Results:
- Significant reductions observed in end-systolic A2 leaflet angle, tenting height, and interpapillary muscle distances after a median of 9 years post-CRT.
- Mitral valve annulus area remained unchanged.
- Interpapillary muscle distance changes correlated with decreased LV volumes and improved LV ejection fraction; A2 leaflet angle and tenting height did not.
Conclusions:
- Long-term CRT leads to favorable geometric remodeling of the mitral valve apparatus, particularly reduced interpapillary muscle distances.
- The correlation between reduced interpapillary muscle distances and improved LV volumes suggests a potential mechanism for CRT benefit.
- A2 leaflet angle and tenting height changes were not significantly associated with LV volume changes post-CRT.
Abstract:
Purpose To assess long-term geometric changes of the mitral valve apparatus using cardiac CT in individuals who underwent cardiac resynchronization therapy (CRT). Materials and Methods Participants from a randomized controlled trial with cardiac CT examinations before CRT implantation and at 6 months follow-up (Clinicaltrials.gov identifier NCT01323686) were invited to undergo an additional long-term follow-up cardiac CT examination. The geometry of the mitral valve apparatus, including mitral valve annulus area, A2 leaflet angle, tenting height, and interpapillary muscle distances, were assessed. Geometric changes at the long-term follow-up examination were reported as mean differences (95% CI), and the Pearson correlation test was used to assess correlation between statistically significant geometric changes and left ventricular (LV) volumes and function. Results Thirty participants (mean age, 68 years ± 9 [SD]; 25 male participants) underwent cardiac CT imaging after a median long-term follow-up of 9.0 years (IQR, 8.4-9.4). There were reductions in end-systolic A2 leaflet angle (-4° [95% CI: -7, -2]), end-systolic tenting height (-1 mm [95% CI: -2, -1]), and end-systolic and end-diastolic interpapillary muscle distances (-4 mm [95% CI: -6, -2]) compared with pre-CRT implantation values. The mitral valve annulus area remained unchanged. LV end-diastolic and end-systolic volumes decreased (-68 mL [95% CI: -99, -37] and -67 mL [95% CI: -96, -39], respectively), and LV ejection fraction increased (13% [95% CI: 7, 19]) at the long-term follow-up examination. Changes in interpapillary muscle distances showed moderate to strong correlations with LV volumes (r = 0.42-0.72; P < .05), while A2 leaflet angle and tenting height were not correlated to LV volumes or function. Conclusion Among the various geometric changes in the mitral valve apparatus after long-term CRT, the reduction in interpapillary muscle distances correlated with LV volumes while the reduced A2 leaflet angle and tenting height did not correlate with LV volumes. Keywords: Mitral Valve Apparatus, Cardiac Resynchronization Therapy, Cardiac CT Supplemental material is available for this article. © RSNA, 2024.
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