The effects of biventricular pacing on mitral coaptation point displacement in patients with heart failure

Stefanos Karagiannis ,George Karatasakis ,A Motsi ,G Athanassopoulos ,Themistoklis Maounis ,Dennis V Cokkinos

doi:10.1016/j.eupc.2005.02.111

Abstract

Purpose In recent years cardiac resynchronisation therapy (CRT) is an established treatment in selected patients with heart failure. Furthermore it has been shown that the displacement of the mitral leaflet coaptation point (CPMA) towards the LV apex correlates with the degree of left ventricular (LV) dysfunction. The purpose of this study is to find the acute effects of biventricular pacing in the mitral apparatus and LV function in heart failure patients. Methods We studied 16 patients (pts) 15 men, 1 woman aged 56±25 years in NYHA class III or IV and left ventricular ejection fraction (LVEF) 22±4%. The etiology was coronary artery disease (CAD) in 7 pts and dilated cardiomyopathy (DCM) in 8 pts. All the patients received cardiac resynchronisation therapy. An echocardiogram was performed within one week after implantation with biventricular pacing (CRT on) and without pacing (CRT off). The CPMA i.e. distance between coaptation point of mitral leaflets and mitral annulus, was measured from the apical 4-chamber view in midsystole and was evaluated with CRT on and CRT off. Echocardiographic indices such as LV end diastolic diameter (LVEDD), end systolic diameter (LVESD), ejection fraction (LVEF) and mitral annulus diameter (MAD) were also measured at CRT off and at CRT on. Results There was a non-significant increase in LVEF, and a non-significant decrease in LVEDD and LVESD with CRT on. CPMA decreased from 10.6±1.9mm at CRT off to 8.1±1.4 at CRT on and MAD decreased from 38.4±4.2 mm at CRT off to 37.7±3.7mm at CRT on (both p<0.05). Moreover the absolute change in CPMA was related to the LVEDD (r=0.74, p<0.05) and inversely related with the LVEF (r= −0.72, p<0.05). Conclusion In patients with severe LV systolic dysfunction and LV dilatation biventricular pacing led to an improvement in both CPMA and MAD. This finding underlines the acute effect of resynchronisation therapy in the mitral apparatus in heart failure patients.

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