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J Thorac Cardiovasc Surg 2008;135:1247-1253
© 2008 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Magnetic resonance imaging assessment of reverse left ventricular remodeling late after restrictive mitral annuloplasty in early stages of dilated cardiomyopathy

Jos J.M. Westenberg, PhDa,*,*, Jerry Braun, MDb,*, Nico R. Van de Veire, MD, PhDc, Robert J.M. Klautz, MD, PhDb, Michel I.M. Versteegh, MDb, Stijntje D. Roes, MDd, Rob J. van der Geest, MSca, Albert de Roos, MD, PhDd, Ernst E. van der Wall, MD, PhDc, Johan H.C. Reiber, PhDa, Jeroen J. Bax, MD, PhDc, Robert A.E. Dion, MD, PhDb

a Department of Radiology, Division of Image Processing, Leiden University Medical Center, The Netherlands
b Department of Cardiothoracic Surgery, Leiden University Medical Center, The Netherlands
c Department of Cardiology, Leiden University Medical Center, The Netherlands
d Department of Radiology, Leiden University Medical Center, The Netherlands

Received for publication May 1, 2007; revisions received September 20, 2007; accepted for publication October 4, 2007.

* Address for reprints: Jos J. M. Westenberg, PhD, Division of Image Processing, Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands. (Email: j.j.m.westenberg{at}lumc.nl).

Objective: Magnetic resonance imaging was used to evaluate left ventricular reverse remodeling at long-term follow-up (3–4 years) after restrictive mitral annuloplasty in patients with early stages of nonischemic, dilated cardiomyopathy, and severe mitral regurgitation.

Methods: Twenty-two selected patients (eligible to undergo magnetic resonance imaging) with mild to moderate heart failure (mean New York Heart Association class 2.2 ± 0.4), dilated cardiomyopathy (left ventricular ejection fraction 37% ± 5%, left ventricular end-diastolic volume 215 ± 34 mL), and severe mitral regurgitation (grade 3–4+) underwent restrictive mitral annuloplasty. Magnetic resonance imaging was performed 1 week before surgery and repeated after 3 to 4 years.

Results: There was no hospital mortality or major morbidity. Two patients died during follow-up (9%), and 2 patients could not undergo repeat magnetic resonance imaging because of comorbidity. New York Heart Association class improved from 2.2 ± 0.4 to 1.2 ± 0.4 (P < .05). Mitral regurgitation was minimal at late echocardiographic follow-up. There were significant decreases in indexed (to body surface area) left atrial end-systolic volume (from 84 ± 20 mL/m2 to 68 ± 12 mL/m2, P < .01), left ventricular end-systolic volume (from 42 ± 14 mL/m2 to 31 ± 12 mL/m2, P < .01), left ventricular end-diastolic volume (from 110 ± 18 mL/m2 to 80 ± 17 mL/m2, P < .01), and left ventricular mass (from 76 ± 21 g/m2 to 66 ± 12 g/m2, P = .03). Forward left ventricular ejection fraction improved from 37% ± 5% to 55% ± 10% (P < .01). Indexed left atrial end-diastolic volume did not show a significant decrease (from 48 ± 16 mL/m2 to 44 ± 10 mL/m2, P = .15).

Conclusion: Magnetic resonance imaging confirms sustained significant reverse left atrial and ventricular remodeling at late (3–4 years) follow-up in patients with nonischemic, dilated cardiomyopathy, and mild to moderate heart failure after restrictive mitral annuloplasty.

Abbreviations and Acronyms "i" = indexation to body surface area; LA = left atrial; LAEDV = left atrial end-diastolic volume; LAESV = left atrial end-systolic volume; LV = left ventricular; LVEDV = left ventricular end-diastolic volume; LVEF = left ventricular ejection fraction; LVESV = left ventricular end-systolic volume; MR = mitral regurgitation; MRI = magnetic resonance imaging; NYHA = New York Heart Association


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