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Randomized Controlled Trial
. 2022 Sep;45(9):921-927.
doi: 10.1002/clc.23879. Epub 2022 Jun 24.

Stage-based approach to predict left ventricular reverse remodeling after mitral repair

Makoto Hibino  1   2 , Nitish K Dhingra  1   2 , Vincent Chan  3   4 , C David Mazer  5   6   7 , Hwee Teoh  1   8 , Adrian Quan  1 , Raj Verma  9 , Howard Leong-Poi  10   11 , Gianluigi Bisleri  1   2 , Kim A Connelly  7   10   11 , Subodh Verma  1   2   12
Affiliations
Randomized Controlled Trial

Stage-based approach to predict left ventricular reverse remodeling after mitral repair

Makoto Hibino et al. Clin Cardiol. 2022 Sep.

Abstract

Background: Although predictors of reverse left ventricular (LV) remodeling postmitral valve repair are critical for guiding perioperative decision-making, there remains a paucity of randomized, prospective data to support the criteria that potential predictor variables must meet.

Methods and results: The CAMRA CardioLink-2 randomized trial allocated 104 patients to either leaflet resection or preservation strategies for mitral repair. The correlation of indexed left ventricular end-systolic volume (LVESVI), indexed left ventricular end-diastolic volume (LVEDVI), and left ventricular ejection fraction (LVEF) were tested with univariate analysis and subsequently with multivariate analysis to determine independent predictors of reverse remodeling at discharge and at 12 months postoperatively. At discharge, both LVESVI and LVEDVI were independently associated with their preoperative values (p < .001 for both) and LVEF by preoperative LVESVI (p < .001). Mitral ring size was favorably associated with the change in LVESVI (p < .05) and LVEF (p < .01) from predischarge to 12 months, while the mean mitral valve gradient after repair was adversely associated with the change in LVESVI (p < .05) and LVEDVI (p < .05). No significant associations were found between reverse remodeling and coaptation height nor mitral repair technique.

Conclusions: Beyond confirming the lack of impact of mitral repair technique on reverse remodeling, this investigation suggests that recommending surgery before significant LV dilatation or dysfunction, as well as higher postoperative mitral valve hemodynamic performance, may enhance remodeling capacity following mitral repair.

Keywords: mitral repair; mitral valve.

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Conflict of interest statement

C. David Mazer reports advisory board honoraria from Amgen, AstraZeneca, Boehringer Ingelheim, and Octapharma. Howard Leong‐Poi hold the Brazilian Ball Chair in Cardiology and reports receiving honoraria for speaking engagements from Lantheus Medical Imaging and Janssen. Subodh Verma holds a Tier 1 Canada Research Chair in Cardiovascular Surgery; and reports receiving research grants and/or speaking honoraria from Amarin, Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol‐Myers Squibb, Eli Lilly, EOCI Pharmacomm Ltd, HLS Therapeutics, Janssen, Merck, Novartis, Novo Nordisk, Pfizer, PhaseBio, Sanofi, Sun Pharmaceuticals, and the Toronto Knowledge Translation Working Group. He is the President of the Canadian Medical and Surgical Knowledge Translation Research Group, a federally incorporated not‐for‐profit physician organization. KAC is listed as an inventor on a patent application by Boehringer Ingelheim on the use of dipeptidyl peptidase‐4 inhibitors in heart failure; and reports receiving research grants to his institution from AstraZeneca, Servier and Boehringer Ingelheim; support for travel to scientific meetings from Boehringer Ingelheim and honoraria for speaking engagements and ad hoc participation in advisory boards from Servier, Merck, Eli Lilly, AstraZeneca, Boehringer Ingelheim, Ferring, Novo Nordisk, Novartis and Janssen. All other authors report no relevant conflicts of interest.

Figures

Figure 1
Figure 1
Remodeling trends in total cohort after mitral repair. § Represents p < .05 for ANOVA and *represents p < .05 when compared with the previous time point. ANOVA, analysis of variance; LV, left ventricular; LVEDVI, left ventricular end‐diastolic volume index; LVEF, left ventricular ejection fraction; LVESVI, left ventricular end‐systolic volume index
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