The role of three-dimensional transesophageal echocardiography in
predicting the effect of cardiac resynchronization therapy on mitral
regurgitation in patients with low ejection fraction heart failure
Abstract
Purpose: Cardiac resynchronization therapy (CRT) has a positive effect
on the improvement of functional mitral regurgitation in patients with
heart failure with reduced ejection fraction. However geometric changes
in the mitral valve apparatus, subvalvular structures and their
contribution to the improvement of mitral regurgitation after CRT have
not been clearly defined. The aim of our study was to evaluate the
geometric parameters of mitral valve apparatus measured with
3Dimensional (3D) transesophageal echocardiography (TEE) before CRT
implantation and to determine the parameters predicting the improvement
of mitral regurgitation after CRT. Methods: In this prospective study
thirty patients with moderate or severe mitral regurgitation with low EF
heart failure planned for CRT implantation and had an indication for TEE
were included. Effective regurgitant orifice (ERO) and regurgitant
volume (RV) measurements were performed before CRT implantation.
Detailed quantitative measurements of mitral valve were done from
recorded images by 3D TEE. ERO, RV measurements were repeated to
evaluate mitral regurgitation at the end of 3rd month. Results: There
were no significant changes in left ventricular EF and left ventricular
diameters at third month follow-up, whereas ERO and RV values were
decreased. posterior leaflet angle was found higher in non-responder
group compared to responder group. (28,93 ± 8,41 vs 41,25 ± 10,90, p =
0,006). Conclusion: Heart failure patients with moderate or severe
functional mitral regurgitation who underwent CRT implantation were
found lower posterior leaflet angle which was measured by 3D TEE in the
patient group whose mitral regurgitation improved after CRT.