American Journal of Cardiovascular Disease Research
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American Journal of Cardiovascular Disease Research. 2013, 1(1), 12-15
DOI: 10.12691/ajcdr-1-1-3
Open AccessArticle

Cardiac Resynchronization Therapy: Effects on Mitral Regurgitation in Heart Failure Patients

Jalal Kheirkhah1, Vahid Toulabi1, Hassan Moladoust1, , Mohammad Asadian Rad1, Hamid Reza Bonakdar1, Anoosh Barzigar1, Fardin Mirbolouk1, Bijan Shad1 and Vahid Nikseresht1

1Cardiovascular Research Center, Heshmat Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran

Pub. Date: July 30, 2013

Cite this paper:
Jalal Kheirkhah, Vahid Toulabi, Hassan Moladoust, Mohammad Asadian Rad, Hamid Reza Bonakdar, Anoosh Barzigar, Fardin Mirbolouk, Bijan Shad and Vahid Nikseresht. Cardiac Resynchronization Therapy: Effects on Mitral Regurgitation in Heart Failure Patients. American Journal of Cardiovascular Disease Research. 2013; 1(1):12-15. doi: 10.12691/ajcdr-1-1-3


Background: Cardiac resynchronization therapy (CRT) has been introduced as a promising therapeutic choice in heart failure patients (HF) with ventricular dyssynchrony, shown with a wide QRS. Objective: This study aimed to evaluate the effect of CRT on the severity of mitral regurgitation (MR) quantitatively using the volumetric Doppler method in HF patients. Patients and methods: This was a prospective before-after survey in which 22 HF patients with wide QRS (≥120 ms) and NYHA class III who were included. All patients were evaluated initially for QRS width, NYHA class, MR volume, MR fraction HF and mitral valve area (MV area). Biventricular pacing was done through cardiac-resynchronization device along with three pacing leads and same evaluations were done after CRT. Results: The mean (SD) QRS width and NYHA class were significantly decreased after CRT in HF patients (P<0.001). Also MR volume (46.9±30.2cc vs. 27.0±26.4cc, P<0.001) and fraction (40.1±25.5% vs. 26.8±22.7%, P=0.002) were improved following CRT. The decrease of MV area after CRT was also significant (10.6±3.0cm2 vs. 8.6±2.6cm2, P<0.001). Conclusion: As MR is associated with morbidity and mortality in HF patients and the standard surgical therapy may not be practical for a majority of them, this novel treatment may improve their disease condition significantly.

cardiac resynchronization therapy hear failure mitral valve insufficiency

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[1]  Roger VL, Go AS, Lloyd-Jones DM, Adams RJ, Berry JD, Brown TM, et al. Heart Disease and Stroke Statistics--2011 update: A report from the American Heart Association. Circulation 2011; 123: 18-209.
[2]  Hekmatpour D, Mohammadi E, Ahmadi F, Arefi SH. Noncompliance factors of congestive heart failure patients readmitted in cardiac care units. Iranian Journal of Critical Care Nursing 2009; 2: 91-97.
[3]  Linde C, Leclercq C, Rex S, Garrigue S, Lavergne T, Cazeau S, et al. Long-Term benefits of biventricular pacing in congestive heart failure: Results from the Multisite Stimulation In Cardiomyopathy (MUSTIC) study. J Am Coll Cardiol 2002; 40:111-118.
[4]  Abraham WT, Fisher WG, Smith AL, Delurgio DB, Leon AR, Loh E, et al. Cardiac resynchronization in chronic heart failure. N Engl J Med 2002; 346: 1845-1853.
[5]  Farwell D, Patel NR, Hall A, Ralph S, Sulke AN. How many people with heart failure are appropriate for biventricular resynchronization? Eur Heart J 2000; 21: 1246-1250.
[6]  Aaronson KD, Schwartz JS, Chen TM, Wong KL, Goin JE, Mancini DM. Development and prospective validation of a clinical index to predict survival in ambulatory patients referred for cardiac transplant evaluation. Circulation 1997; 95: 2660-2667.
[7]  Acosta H, Viafara L M, Izquierdo D, Adams D, Pothula V R, Wallner H, et al. Reduction of mitral regurgitation by biventricular pacing with intraventriuclar timing optimization in patients without a standard indication: A potential new indication for Cardiac Resynchronization Therapy. The Journal of Innovations in Cardiac Rhythm Management 2012; 3: 784-790.
[8]  St.John Sutton MG, Plappert T, Abraham WT, Smith AL, DeLurgio DB, Leon AR, et al. Effect of cardiac resynchronization on left ventricular size and function in chronic heart failure. Circulation 2003; 107: 1985-1990.
[9]  Horwich T, Foster E, De Marco T, Tseng Z, Saxon L. Effects of resynchronization therapy on cardiac function in pacemaker patients upgraded to biventricular devices. J Cardiovasc Electrophysiol 2004; 15: 1284-1289.
[10]  Cleland JG, Daubert JC, Erdmann E, Freemantle N, Gras D, Kappenberger L, Tavazzi L. The effect of cardiac resynchronization on morbidity and mortality in heart failure. N Engl J Med 2005; 352: 1539-1549.
[11]  Eskesen K, Kanagalingam S, Abraham TP. Mitral Regurgitation in Cardiac Resynchronization. Solving another piece of puzzle. Circ Cardiovasc Imaging 2009; 2: 427-428.
[12]  Ypenburg C, Lancellotti P, Tops LF, Bleeker GB, Holman ER, Pierard LA, et al. Acute effects of initiation and withdrawal of cardiac resynchronization therapy on papillary muscle dyssynchrony and mitral regurgitation. J Am Coll Cardiol 2007; 50: 2071-2077.
[13]  Lancellotti P, Melon P, Sakalihasan N, Waleffe A, Dubois C, Bertholet M, Pierard LA. Effect of cardiac resynchronization therapy on functional mitral regurgitation in heart failure. Am J Cardiol 2004; 94: 1462-1465.
[14]  Kanzaki H, Bazaz R, Schwartzman D, Dohi K, Sade LE, Gorcsan J 3rd. A mechanism for immediate reduction in mitral regurgitation after cardiac resynchronization therapy. J Am Coll Cardiol 2004; 44: 1619-1625.
[15]  Disney PJ, Ashby DT, Young GD, Bradley JA. Ventricular pacing for severe mitral regurgitation following atrioventricular nodal ablation. Pacing Clin Elecrophys 2003; 26: 643-644.
[16]  Breithardt OA, Sinha AM, Franke A, Hanrath P, Stellbrink C. Echocardiography in cardiac resynchronization therapy: Identification of suitable patients, follow-up and therapy optimization. Herz 2003; 28: 615-627.
[17]  Irwin JM, Glover MU, Barold SS. Treatment of pacemaker induced severe mitral regurgitation with biventricular pacing in two patients with a normal left ventricular ejection fraction. Pacing Clin Electrophysiol 2003; 26: 2333-2335.
[18]  Sutton MG, Plappert T, Hilpisch KE, Abraham WT, Hayesn DL, Chinchoy E. Sustained reverse left ventricular structural remodeling with cardiac resynchronization at one year is a function of etiology: Quantitative Doppler echocardiographic evidence from the Multicenter InSync Randomized Clinical Evaluation (MIRACLE). Circulation 2006; 113: 266-272.
[19]  Auricchio A, Stellbrink C, Sack S, Block M, Vogt J, Bakker P, et al. Long-lerm clinical effect of hemodynamically optimized cardiac resynchronization therapy in patients with heart failure and ventricular conduction delay. J Am Coll Cardiol 2002; 39: 2026-2033.
[20]  Bristow MR, Saxon LA, Boehmer J, Krueger S, Kass DA, De Marco T, et al. Comparison of medical therapy, pacing, and defibrillation in heart failure (COMPANION) investigators: Cardiacresynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure. N Engl J Med 2004; 350: 2140-2150.
[21]  Young JB, Abraham WT, Smith AL, Leon AR, Lieberman R, Wilkoff B, et al. Combined cardiac resynchronization and implantable cardioversion defibrillation in advanced chronic heart failure. JAMA 2003; 289: 2685-2694.
[22]  Gras D, Leclercq C, Tang AS, Bucknall C, Luttikhuis HO, Kirstein-Pedersen A. Cardiac resynchronization therapy in advanced heart failure. Eur J Heart Fail 2002; 4: 311-320.
[23]  Etienne Y, Mansourati J, Touiza A, Gilard M, Bertault-Valls V, GuilloPh, et al. Evaluation of left ventricular function and mitral regurgitation during left ventricular-based pacing in patients with heart failure. Eur J Heart Fail 2001; 3: 441-447.
[24]  Breithardt OA, Sinha AM, Schwammenthal E, Bidaoui N, Markus KU, Franke A, Stellbrink C. Acute effects of cardiac resynchronization therapy on functional mitral regurgitation in advanced systolic heart failure. J Am Coll Cardiol 2003; 41: 765-770.