The Impact of Preoperative Left Ventricular Systolic Dysfunction on Reverse Remodelling Following Mitral Repair: Insights from CAMRA CardioLink-2 Randomized Trial
Presented During:
Friday, May 5, 2023: 7:50AM - 7:55AM
New York Hilton Midtown
Posted Room Name:
Petit Trianon
Abstract No:
MO066
Submission Type:
Abstract Submission
Authors:
Makoto Hibino (1), Raj Verma (2), Vincent Chan (3), C David Mazer (4), Adrian Quan (5), Hwee Teoh (5), Bobby Yanagawa (6), Gianluigi Bisleri (7), Kim Connelly (8), Subodh Verma (5)
Institutions:
(1) St Michael's Hospital, Toronto, ON, (2) Royal College of Surgeons, Dublin, NA, (3) University of Ottawa Heart Institute, Ottawa, ON, (4) Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, (5) St. Michael's Hospital, Toronto, ON, (6) University of Toronto, Toronto, ON, (7) St. Michael’s Hospital, Toronto, ON, (8) Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, Ontario
Submitting Author:
Makoto Hibino
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St Michael's Hospital
St Michael's Hospital
Co-Author(s):
Raj Verma
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Royal College of Surgeons
Royal College of Surgeons
*Vincent Chan
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University of Ottawa Heart Institute
University of Ottawa Heart Institute
C David Mazer
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Li Ka Shing Knowledge Institute of St. Michael's Hospital
Li Ka Shing Knowledge Institute of St. Michael's Hospital
Adrian Quan
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St. Michael's Hospital
St. Michael's Hospital
Hwee Teoh
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St. Michael's Hospital
St. Michael's Hospital
*Bobby Yanagawa
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University of Toronto
University of Toronto
Gianluigi Bisleri
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St. Michael’s Hospital
St. Michael’s Hospital
Kim Connelly
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Li Ka Shing Knowledge Institute of St. Michael’s Hospital
Li Ka Shing Knowledge Institute of St. Michael’s Hospital
*Subodh Verma
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St. Michael's Hospital
St. Michael's Hospital
Presenting Author:
Makoto Hibino
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St Michael's Hospital
St Michael's Hospital
Abstract:
Objective: The ideal time to undergo mitral repair surgery for degenerative mitral regurgitation is before patients develop systolic dysfunction defined as LVEF ≤60% or LVESD ≥40 mm. We studied the impact of systolic dysfunction on the LV reverse remodeling in the sub-analysis of The Canadian Mitral Research Alliance CardioLink-2 study, a randomized trial comparing leaflet resection versus preservation techniques for posterior leaflet prolapse.
Methods: A total of 74 patients were included in the analysis and divided into 2 groups, those with or without preoperative systolic dysfunction. We compared changes in echocardiography up to 12 months postoperatively.
Results: Systolic dysfunction was identified in 35 participants. Patient characteristics were not significantly different except for higher prevalence of atrial fibrillation in those with systolic dysfunction (17 (49%), vs. 6 (15%), p=0.003). At baseline, those with systolic dysfunction had significantly larger mean LV geometry (57.4mm, 39.9mm, 194.3ml, and 81.0ml vs. 52.2mm, 32.0mm, 162.2ml, and 58.6ml in LVEDD, LVESD, LVEDV, and LVESV, respectively). This association was unchanged before discharge and at 12 months (50.4mm, 35.5mm, 140.8ml, and 63.7ml vs. 46.4mm, 32.5mm, 120.3ml, and 51.4ml, respectively at 12 months); however, those with systolic dysfunction had better (-1.8mm vs +2.1mm, p<0.001 in mean LVESD change) or equivalent (-4.9mm and -38.8ml vs -2.9mm and -31.2ml, p=0.061 and 0.37 in mean LVEDD and LVEDV change) reverse remodeling in acute phase (before discharge vs baseline). In mid-term phase (12 months vs before discharge), those with systolic dysfunction had significant reverse remodeling which was equivalent to those without systolic dysfunction (-2.4mm, -2.8mm and -13.2ml vs -2.9mm, -1.7mm and -12.0ml, p=0.71, p=0.43 and 0.83 in mean LVEDD, LVESD and LVESV change). Those with systolic dysfunction had lower LVEF at baseline (57.7% vs 64.1%, p<0.001), before discharge (48.1% vs 53.5%, p=0.013) and at 12 months (55.1% vs 57.6%, p=0.045) but had significant recovery in mid-term phase which was equivalent to those without systolic dysfunction (4.1% vs 4.5%, p=0.84).
Conclusions: Those with preoperative systolic dysfunction had greater LV dimensions and volumes and lower LVEF postoperatively than those without systolic dysfunction; however, both the groups had similar reverse remodeling both in acute and mid-term phase. Further study is warranted to investigate long-term trends.
Methods: A total of 74 patients were included in the analysis and divided into 2 groups, those with or without preoperative systolic dysfunction. We compared changes in echocardiography up to 12 months postoperatively.
Results: Systolic dysfunction was identified in 35 participants. Patient characteristics were not significantly different except for higher prevalence of atrial fibrillation in those with systolic dysfunction (17 (49%), vs. 6 (15%), p=0.003). At baseline, those with systolic dysfunction had significantly larger mean LV geometry (57.4mm, 39.9mm, 194.3ml, and 81.0ml vs. 52.2mm, 32.0mm, 162.2ml, and 58.6ml in LVEDD, LVESD, LVEDV, and LVESV, respectively). This association was unchanged before discharge and at 12 months (50.4mm, 35.5mm, 140.8ml, and 63.7ml vs. 46.4mm, 32.5mm, 120.3ml, and 51.4ml, respectively at 12 months); however, those with systolic dysfunction had better (-1.8mm vs +2.1mm, p<0.001 in mean LVESD change) or equivalent (-4.9mm and -38.8ml vs -2.9mm and -31.2ml, p=0.061 and 0.37 in mean LVEDD and LVEDV change) reverse remodeling in acute phase (before discharge vs baseline). In mid-term phase (12 months vs before discharge), those with systolic dysfunction had significant reverse remodeling which was equivalent to those without systolic dysfunction (-2.4mm, -2.8mm and -13.2ml vs -2.9mm, -1.7mm and -12.0ml, p=0.71, p=0.43 and 0.83 in mean LVEDD, LVESD and LVESV change). Those with systolic dysfunction had lower LVEF at baseline (57.7% vs 64.1%, p<0.001), before discharge (48.1% vs 53.5%, p=0.013) and at 12 months (55.1% vs 57.6%, p=0.045) but had significant recovery in mid-term phase which was equivalent to those without systolic dysfunction (4.1% vs 4.5%, p=0.84).
Conclusions: Those with preoperative systolic dysfunction had greater LV dimensions and volumes and lower LVEF postoperatively than those without systolic dysfunction; however, both the groups had similar reverse remodeling both in acute and mid-term phase. Further study is warranted to investigate long-term trends.
Mitral Conclave:
Mitral Regurgitation in Heart Failure
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