Early and late effects of cardiac resynchronization therapy on exercise-induced mitral regurgitation: relationship with left ventricular dyssynchrony, remodelling and cardiopulmonary performance
Aims Exercise-induced mitral regurgitation (MR) bears a poor prognosis in patients with congestive heart failure (CHF). Cardiac resynchronization therapy (CRT) is associated with improved clinical outcome but its effects on exercise-induced MR remain undetermined. We investigated serial changes in f...
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| Veröffentlicht in: | European heart journal 2007-09, Vol.28 (17), p.2134-2141 |
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| creator | Madaric, Juraj Vanderheyden, Marc Van Laethem, Christophe Verhamme, Katia Feys, Ann Goethals, Marc Verstreken, Sofie Geelen, Peter Penicka, Martin De Bruyne, Bernard Bartunek, Jozef |
| description | Aims Exercise-induced mitral regurgitation (MR) bears a poor prognosis in patients with congestive heart failure (CHF). Cardiac resynchronization therapy (CRT) is associated with improved clinical outcome but its effects on exercise-induced MR remain undetermined. We investigated serial changes in functional MR in relation to left ventricular (LV) remodelling and cardiopulmonary performance after CRT. Methods and results Twenty-eight patients with CHF (LV ejection fraction 25 ± 7%), broad QRS complex (171 ± 27 ms), and at least mild MR [effective regurgitant orifice (ERO) 0.25 ± 0.12 cm2] were studied with quantitative exercise echocardiography and cardiopulmonary exercise testing prior, within 1 week, and 3 months after CRT. Early after CRT, a decrease in LV dyssynchrony (from 54 ± 21 to 19 ± 7 ms, P < 0.001) and in MR at rest (ERO from 0.25 ± 0.12 to 0.20 ± 0.10 cm2, P = 0.047) was observed. However, no change in exercise-induced increase in MR was observed (ERO from 0.34 ± 0.12 to 0.31 ± 0.16 cm2, NS). Three months after CRT, a decrease in the mitral valve tenting area (from 3.3 ± 1.2 to 2.0 ± 0.6 cm2, P < 0.001) and an increase in LV sphericity index (from 1.5 ± 0.3 to 1.8 ± 0.5, P < 0.001) were paralleled by an attenuation of exercise-induced MR (ERO 0.19 ± 0.06 cm2, P = 0.001 vs. prior CRT). This was associated with an increase in LV ejection fraction (from 25 ± 7 to 35 ± 9%, P < 0.001), peak oxygen uptake (from 11.7 ± 2.4 to 13.7 ± 3.8 mL/kg/min, P = 0.001), and a decrease in Nt-pro-BNP (from 2777 ± 1681 to 1963 ± 1361 pg/mL, P = 0.067). Conclusion CRT is associated with acute decrease in resting MR but does not immediately attenuate exercise-induced MR. In contrast, only late, CRT-induced reversed LV remodelling and reduced mitral apparatus deformation are associated with a reduction in both resting and exercise-induced MR and with an improvement in cardiopulmonary performance. |
| doi_str_mv | 10.1093/eurheartj/ehm126 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_68224666</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><oup_id>10.1093/eurheartj/ehm126</oup_id><sourcerecordid>68224666</sourcerecordid><originalsourceid>FETCH-LOGICAL-c440t-543bb309f6ac2441c0ef53fa5403bedacf769372cfa8f605ce8a4dabc229ca9b3</originalsourceid><addsrcrecordid>eNqNkUFv1DAQhSMEokvhzglZHLhAqO0k3oQbKi1FKuICqOJiTZzxxktiB9uBhp_HL8PdXYrEiZPH0vee3_hl2WNGXzLaFCc4-x7Bx-0J9iPj4k62YhXneSPK6m62oqypciHqq6PsQQhbSmktmLifHbF1Rcua8lX26wz8sBCwHRkgIkGtUcVAnCYKfGdAEY9hsar3zpqfEI2zJPboYVpIGvEavTIBc2O7WWFHRhM9DEm0mf3GxJ3gVboOuyn0ZiI_TOzJgDqS72ijN2oewJNuCX_eWV4kweg6HAZjN7twuzBumofRWfALmdBr50ewCh9m9zQMAR8dzuPs0_nZx9OL_PLD23enry9zVZY05lVZtG1BGy1A8bJkiqKuCg1VSYsWO1B6LZpizZWGWgtaKayh7KBVnDcKmrY4zp7tfSfvvs0YohxNUCkjWHRzkKLmvBRCJPDpP-DWzd6mbJKz6ubnS5YguoeUdyF41HLyZkyrSUblTbnytly5LzdJnhx853bE7q_g0GYCnu8BN0__Y5fvaRMiXt_y4L9KsS7Wlby4-iI_n79nTU1r-ab4DWtWybo</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>215504841</pqid></control><display><type>article</type><title>Early and late effects of cardiac resynchronization therapy on exercise-induced mitral regurgitation: relationship with left ventricular dyssynchrony, remodelling and cardiopulmonary performance</title><source>MEDLINE</source><source>Oxford University Press Journals All Titles (1996-Current)</source><source>EZB-FREE-00999 freely available EZB journals</source><creator>Madaric, Juraj ; Vanderheyden, Marc ; Van Laethem, Christophe ; Verhamme, Katia ; Feys, Ann ; Goethals, Marc ; Verstreken, Sofie ; Geelen, Peter ; Penicka, Martin ; De Bruyne, Bernard ; Bartunek, Jozef</creator><creatorcontrib>Madaric, Juraj ; Vanderheyden, Marc ; Van Laethem, Christophe ; Verhamme, Katia ; Feys, Ann ; Goethals, Marc ; Verstreken, Sofie ; Geelen, Peter ; Penicka, Martin ; De Bruyne, Bernard ; Bartunek, Jozef</creatorcontrib><description>Aims Exercise-induced mitral regurgitation (MR) bears a poor prognosis in patients with congestive heart failure (CHF). Cardiac resynchronization therapy (CRT) is associated with improved clinical outcome but its effects on exercise-induced MR remain undetermined. We investigated serial changes in functional MR in relation to left ventricular (LV) remodelling and cardiopulmonary performance after CRT. Methods and results Twenty-eight patients with CHF (LV ejection fraction 25 ± 7%), broad QRS complex (171 ± 27 ms), and at least mild MR [effective regurgitant orifice (ERO) 0.25 ± 0.12 cm2] were studied with quantitative exercise echocardiography and cardiopulmonary exercise testing prior, within 1 week, and 3 months after CRT. Early after CRT, a decrease in LV dyssynchrony (from 54 ± 21 to 19 ± 7 ms, P < 0.001) and in MR at rest (ERO from 0.25 ± 0.12 to 0.20 ± 0.10 cm2, P = 0.047) was observed. However, no change in exercise-induced increase in MR was observed (ERO from 0.34 ± 0.12 to 0.31 ± 0.16 cm2, NS). Three months after CRT, a decrease in the mitral valve tenting area (from 3.3 ± 1.2 to 2.0 ± 0.6 cm2, P < 0.001) and an increase in LV sphericity index (from 1.5 ± 0.3 to 1.8 ± 0.5, P < 0.001) were paralleled by an attenuation of exercise-induced MR (ERO 0.19 ± 0.06 cm2, P = 0.001 vs. prior CRT). This was associated with an increase in LV ejection fraction (from 25 ± 7 to 35 ± 9%, P < 0.001), peak oxygen uptake (from 11.7 ± 2.4 to 13.7 ± 3.8 mL/kg/min, P = 0.001), and a decrease in Nt-pro-BNP (from 2777 ± 1681 to 1963 ± 1361 pg/mL, P = 0.067). Conclusion CRT is associated with acute decrease in resting MR but does not immediately attenuate exercise-induced MR. In contrast, only late, CRT-induced reversed LV remodelling and reduced mitral apparatus deformation are associated with a reduction in both resting and exercise-induced MR and with an improvement in cardiopulmonary performance.</description><identifier>ISSN: 0195-668X</identifier><identifier>EISSN: 1522-9645</identifier><identifier>DOI: 10.1093/eurheartj/ehm126</identifier><identifier>PMID: 17504802</identifier><language>eng</language><publisher>England: Oxford University Press</publisher><subject>Aged ; Cardiac Pacing, Artificial - methods ; Cardiac resynchronization ; Cardiopulmonary performance ; Echocardiography, Doppler ; Exercise ; Exercise - physiology ; Exercise Test - methods ; Female ; Heart failure ; Heart Failure - physiopathology ; Heart Failure - therapy ; Heart Function Tests - methods ; Humans ; Male ; Mitral insufficiency ; Mitral Valve Insufficiency - etiology ; Mitral Valve Insufficiency - physiopathology ; Mitral Valve Insufficiency - prevention & control ; Oxygen Consumption - physiology ; Pacemaker, Artificial ; Ventricular Dysfunction, Left - physiopathology ; Ventricular Dysfunction, Left - therapy ; Ventricular Remodeling - physiology</subject><ispartof>European heart journal, 2007-09, Vol.28 (17), p.2134-2141</ispartof><rights>The European Society of Cardiology 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org 2007</rights><rights>The European Society of Cardiology 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c440t-543bb309f6ac2441c0ef53fa5403bedacf769372cfa8f605ce8a4dabc229ca9b3</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,1583,27923,27924</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/17504802$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Madaric, Juraj</creatorcontrib><creatorcontrib>Vanderheyden, Marc</creatorcontrib><creatorcontrib>Van Laethem, Christophe</creatorcontrib><creatorcontrib>Verhamme, Katia</creatorcontrib><creatorcontrib>Feys, Ann</creatorcontrib><creatorcontrib>Goethals, Marc</creatorcontrib><creatorcontrib>Verstreken, Sofie</creatorcontrib><creatorcontrib>Geelen, Peter</creatorcontrib><creatorcontrib>Penicka, Martin</creatorcontrib><creatorcontrib>De Bruyne, Bernard</creatorcontrib><creatorcontrib>Bartunek, Jozef</creatorcontrib><title>Early and late effects of cardiac resynchronization therapy on exercise-induced mitral regurgitation: relationship with left ventricular dyssynchrony, remodelling and cardiopulmonary performance</title><title>European heart journal</title><addtitle>Eur Heart J</addtitle><description>Aims Exercise-induced mitral regurgitation (MR) bears a poor prognosis in patients with congestive heart failure (CHF). Cardiac resynchronization therapy (CRT) is associated with improved clinical outcome but its effects on exercise-induced MR remain undetermined. We investigated serial changes in functional MR in relation to left ventricular (LV) remodelling and cardiopulmonary performance after CRT. Methods and results Twenty-eight patients with CHF (LV ejection fraction 25 ± 7%), broad QRS complex (171 ± 27 ms), and at least mild MR [effective regurgitant orifice (ERO) 0.25 ± 0.12 cm2] were studied with quantitative exercise echocardiography and cardiopulmonary exercise testing prior, within 1 week, and 3 months after CRT. Early after CRT, a decrease in LV dyssynchrony (from 54 ± 21 to 19 ± 7 ms, P < 0.001) and in MR at rest (ERO from 0.25 ± 0.12 to 0.20 ± 0.10 cm2, P = 0.047) was observed. However, no change in exercise-induced increase in MR was observed (ERO from 0.34 ± 0.12 to 0.31 ± 0.16 cm2, NS). Three months after CRT, a decrease in the mitral valve tenting area (from 3.3 ± 1.2 to 2.0 ± 0.6 cm2, P < 0.001) and an increase in LV sphericity index (from 1.5 ± 0.3 to 1.8 ± 0.5, P < 0.001) were paralleled by an attenuation of exercise-induced MR (ERO 0.19 ± 0.06 cm2, P = 0.001 vs. prior CRT). This was associated with an increase in LV ejection fraction (from 25 ± 7 to 35 ± 9%, P < 0.001), peak oxygen uptake (from 11.7 ± 2.4 to 13.7 ± 3.8 mL/kg/min, P = 0.001), and a decrease in Nt-pro-BNP (from 2777 ± 1681 to 1963 ± 1361 pg/mL, P = 0.067). Conclusion CRT is associated with acute decrease in resting MR but does not immediately attenuate exercise-induced MR. In contrast, only late, CRT-induced reversed LV remodelling and reduced mitral apparatus deformation are associated with a reduction in both resting and exercise-induced MR and with an improvement in cardiopulmonary performance.</description><subject>Aged</subject><subject>Cardiac Pacing, Artificial - methods</subject><subject>Cardiac resynchronization</subject><subject>Cardiopulmonary performance</subject><subject>Echocardiography, Doppler</subject><subject>Exercise</subject><subject>Exercise - physiology</subject><subject>Exercise Test - methods</subject><subject>Female</subject><subject>Heart failure</subject><subject>Heart Failure - physiopathology</subject><subject>Heart Failure - therapy</subject><subject>Heart Function Tests - methods</subject><subject>Humans</subject><subject>Male</subject><subject>Mitral insufficiency</subject><subject>Mitral Valve Insufficiency - etiology</subject><subject>Mitral Valve Insufficiency - physiopathology</subject><subject>Mitral Valve Insufficiency - prevention & control</subject><subject>Oxygen Consumption - physiology</subject><subject>Pacemaker, Artificial</subject><subject>Ventricular Dysfunction, Left - physiopathology</subject><subject>Ventricular Dysfunction, Left - therapy</subject><subject>Ventricular Remodeling - physiology</subject><issn>0195-668X</issn><issn>1522-9645</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2007</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkUFv1DAQhSMEokvhzglZHLhAqO0k3oQbKi1FKuICqOJiTZzxxktiB9uBhp_HL8PdXYrEiZPH0vee3_hl2WNGXzLaFCc4-x7Bx-0J9iPj4k62YhXneSPK6m62oqypciHqq6PsQQhbSmktmLifHbF1Rcua8lX26wz8sBCwHRkgIkGtUcVAnCYKfGdAEY9hsar3zpqfEI2zJPboYVpIGvEavTIBc2O7WWFHRhM9DEm0mf3GxJ3gVboOuyn0ZiI_TOzJgDqS72ijN2oewJNuCX_eWV4kweg6HAZjN7twuzBumofRWfALmdBr50ewCh9m9zQMAR8dzuPs0_nZx9OL_PLD23enry9zVZY05lVZtG1BGy1A8bJkiqKuCg1VSYsWO1B6LZpizZWGWgtaKayh7KBVnDcKmrY4zp7tfSfvvs0YohxNUCkjWHRzkKLmvBRCJPDpP-DWzd6mbJKz6ubnS5YguoeUdyF41HLyZkyrSUblTbnytly5LzdJnhx853bE7q_g0GYCnu8BN0__Y5fvaRMiXt_y4L9KsS7Wlby4-iI_n79nTU1r-ab4DWtWybo</recordid><startdate>20070901</startdate><enddate>20070901</enddate><creator>Madaric, Juraj</creator><creator>Vanderheyden, Marc</creator><creator>Van Laethem, Christophe</creator><creator>Verhamme, Katia</creator><creator>Feys, Ann</creator><creator>Goethals, Marc</creator><creator>Verstreken, Sofie</creator><creator>Geelen, Peter</creator><creator>Penicka, Martin</creator><creator>De Bruyne, Bernard</creator><creator>Bartunek, Jozef</creator><general>Oxford University Press</general><general>Oxford Publishing Limited (England)</general><scope>BSCLL</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QP</scope><scope>K9.</scope><scope>7X8</scope></search><sort><creationdate>20070901</creationdate><title>Early and late effects of cardiac resynchronization therapy on exercise-induced mitral regurgitation: relationship with left ventricular dyssynchrony, remodelling and cardiopulmonary performance</title><author>Madaric, Juraj ; Vanderheyden, Marc ; Van Laethem, Christophe ; Verhamme, Katia ; Feys, Ann ; Goethals, Marc ; Verstreken, Sofie ; Geelen, Peter ; Penicka, Martin ; De Bruyne, Bernard ; Bartunek, Jozef</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c440t-543bb309f6ac2441c0ef53fa5403bedacf769372cfa8f605ce8a4dabc229ca9b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2007</creationdate><topic>Aged</topic><topic>Cardiac Pacing, Artificial - methods</topic><topic>Cardiac resynchronization</topic><topic>Cardiopulmonary performance</topic><topic>Echocardiography, Doppler</topic><topic>Exercise</topic><topic>Exercise - physiology</topic><topic>Exercise Test - methods</topic><topic>Female</topic><topic>Heart failure</topic><topic>Heart Failure - physiopathology</topic><topic>Heart Failure - therapy</topic><topic>Heart Function Tests - methods</topic><topic>Humans</topic><topic>Male</topic><topic>Mitral insufficiency</topic><topic>Mitral Valve Insufficiency - etiology</topic><topic>Mitral Valve Insufficiency - physiopathology</topic><topic>Mitral Valve Insufficiency - prevention & control</topic><topic>Oxygen Consumption - physiology</topic><topic>Pacemaker, Artificial</topic><topic>Ventricular Dysfunction, Left - physiopathology</topic><topic>Ventricular Dysfunction, Left - therapy</topic><topic>Ventricular Remodeling - physiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Madaric, Juraj</creatorcontrib><creatorcontrib>Vanderheyden, Marc</creatorcontrib><creatorcontrib>Van Laethem, Christophe</creatorcontrib><creatorcontrib>Verhamme, Katia</creatorcontrib><creatorcontrib>Feys, Ann</creatorcontrib><creatorcontrib>Goethals, Marc</creatorcontrib><creatorcontrib>Verstreken, Sofie</creatorcontrib><creatorcontrib>Geelen, Peter</creatorcontrib><creatorcontrib>Penicka, Martin</creatorcontrib><creatorcontrib>De Bruyne, Bernard</creatorcontrib><creatorcontrib>Bartunek, Jozef</creatorcontrib><collection>Istex</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>European heart journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Madaric, Juraj</au><au>Vanderheyden, Marc</au><au>Van Laethem, Christophe</au><au>Verhamme, Katia</au><au>Feys, Ann</au><au>Goethals, Marc</au><au>Verstreken, Sofie</au><au>Geelen, Peter</au><au>Penicka, Martin</au><au>De Bruyne, Bernard</au><au>Bartunek, Jozef</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Early and late effects of cardiac resynchronization therapy on exercise-induced mitral regurgitation: relationship with left ventricular dyssynchrony, remodelling and cardiopulmonary performance</atitle><jtitle>European heart journal</jtitle><addtitle>Eur Heart J</addtitle><date>2007-09-01</date><risdate>2007</risdate><volume>28</volume><issue>17</issue><spage>2134</spage><epage>2141</epage><pages>2134-2141</pages><issn>0195-668X</issn><eissn>1522-9645</eissn><abstract>Aims Exercise-induced mitral regurgitation (MR) bears a poor prognosis in patients with congestive heart failure (CHF). Cardiac resynchronization therapy (CRT) is associated with improved clinical outcome but its effects on exercise-induced MR remain undetermined. We investigated serial changes in functional MR in relation to left ventricular (LV) remodelling and cardiopulmonary performance after CRT. Methods and results Twenty-eight patients with CHF (LV ejection fraction 25 ± 7%), broad QRS complex (171 ± 27 ms), and at least mild MR [effective regurgitant orifice (ERO) 0.25 ± 0.12 cm2] were studied with quantitative exercise echocardiography and cardiopulmonary exercise testing prior, within 1 week, and 3 months after CRT. Early after CRT, a decrease in LV dyssynchrony (from 54 ± 21 to 19 ± 7 ms, P < 0.001) and in MR at rest (ERO from 0.25 ± 0.12 to 0.20 ± 0.10 cm2, P = 0.047) was observed. However, no change in exercise-induced increase in MR was observed (ERO from 0.34 ± 0.12 to 0.31 ± 0.16 cm2, NS). Three months after CRT, a decrease in the mitral valve tenting area (from 3.3 ± 1.2 to 2.0 ± 0.6 cm2, P < 0.001) and an increase in LV sphericity index (from 1.5 ± 0.3 to 1.8 ± 0.5, P < 0.001) were paralleled by an attenuation of exercise-induced MR (ERO 0.19 ± 0.06 cm2, P = 0.001 vs. prior CRT). This was associated with an increase in LV ejection fraction (from 25 ± 7 to 35 ± 9%, P < 0.001), peak oxygen uptake (from 11.7 ± 2.4 to 13.7 ± 3.8 mL/kg/min, P = 0.001), and a decrease in Nt-pro-BNP (from 2777 ± 1681 to 1963 ± 1361 pg/mL, P = 0.067). Conclusion CRT is associated with acute decrease in resting MR but does not immediately attenuate exercise-induced MR. In contrast, only late, CRT-induced reversed LV remodelling and reduced mitral apparatus deformation are associated with a reduction in both resting and exercise-induced MR and with an improvement in cardiopulmonary performance.</abstract><cop>England</cop><pub>Oxford University Press</pub><pmid>17504802</pmid><doi>10.1093/eurheartj/ehm126</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Aged Cardiac Pacing, Artificial - methods Cardiac resynchronization Cardiopulmonary performance Echocardiography, Doppler Exercise Exercise - physiology Exercise Test - methods Female Heart failure Heart Failure - physiopathology Heart Failure - therapy Heart Function Tests - methods Humans Male Mitral insufficiency Mitral Valve Insufficiency - etiology Mitral Valve Insufficiency - physiopathology Mitral Valve Insufficiency - prevention & control Oxygen Consumption - physiology Pacemaker, Artificial Ventricular Dysfunction, Left - physiopathology Ventricular Dysfunction, Left - therapy Ventricular Remodeling - physiology |
| title | Early and late effects of cardiac resynchronization therapy on exercise-induced mitral regurgitation: relationship with left ventricular dyssynchrony, remodelling and cardiopulmonary performance |
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