https://orcid.org/0000-0002-0110-9054
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ABSTRACT
Background: The short and long-term effects of volume overload elimination on left ventricular (LV) volumetric reverse-remodeling and systemic hemodynamic after surgery for chronic primary mitral regurgitation (MR) have been poorly explored.
Methods: 224 patients (64 ± 13 years) with primary MR underwent serial MR and LV volumetric measurements at baseline, early (5[4–6] days) and late (428 [355–688] days) after surgery.
Results: Early after surgery, the drop in LV end-diastolic volume (EDV index: 119 ± 25 to 75 ± 14 mL/m2, P < 0.0001) was tightly related to pre-operative regurgitant volume (RVol; r = 0.88, P < 0.0001) while end-systolic volume (ESV) index did not change. Although LV ejection fraction (EF) decreased (71 ± 8 to 54 ± 12%, P < 0.0001), forward stroke volume was maintained (P = 0.28). Patients with greater RVol experienced a greater decrease in EDV and LVEF. Later, ESV index decreased (P < 0.0001), EDV index decreased further and LVEF improved to 60 ± 8% (P < 0.0001). Finally, systemic vascular function changes were characterized by an improvement in resistance and compliance.
Conclusion: LV volumetric reverse-remodeling after surgery for primary MR is a phased process. The initial response is driven essentially by elimination of MR with a greater decline in EF in patients with larger RVol. In the late phase LV systolic function improvement is generally observed. Overall, the degree of LV reverse-remodeling is related to the magnitude of RVol, which predicts the early decline in EDV. Finally, LV reverse-remodeling is associated to systemic vascular function remodeling.
Disclosure statement
None of the authors have any conflict of interest to disclose