Reverse remodeling of mitral leaflets after medical treatment in recent-onset dilated cardiomyopathy
Abstract
Background: The growth of mitral leaflets (MLs) adaptive to left ventricluar (LV) remodeling has been observed. However, the elasticity of MLs upon mechanical stimuli would be supposed if it shrinks with LV reverse remodeling (LVRR).
Material and methods: Patients with idiopathic recent-onset dilated cardiomyopathy (RODCM) (n = 82) and 50 matched normal controls (NC) were prospectively enrolled. Echocardiography was performed at baseline and 6 months of follow-up for the anterior and posterior mitral leaflet (AML and PML) length, mitral annular dimension (MAD), and tenting height (TH). LVRR was measured as a ≥ 15% reduction in LV end-diastolic volume (LVEDV).
Results: After 6 months, LVRR was achieved in 69.5% of patients. The AML (28 ± 3 vs. 26 ± 3 mm, p = 0.004) and PML (19 ± 4 vs. 17 ± 3 mm, p < 0.001) decreased in length, as well as the MAD (31 ± 5 vs. 28 ± 5 mm, p = 0.001) and TH (10 ± 3 vs. 8 ± 2 mm, p < 0.001). Compared with the NC group, the AML and PML of the RODCM group were 16.7% and 35.7% longer at baseline and remained 8.3% and 21.2% longer at follow-up, respectively. The change in AML or PML correlated moderately with that in LVEDV (r = 0.487, p < 0.001; r = 0.516, p < 0.001, respectively). The AML and PML length decreased in the LVRR (+) subgroup (AML, 28 ± 3 vs. 26 ± 3 mm, p = 0.001; PML, 20 ± 4 vs. 16 ± 3 mm, p < 0.001), but remained the same in the LVRR (-) subgroup (27 ± 4 vs. 28 ± 4 mm, p = 0.318; 17 ± 3 vs. 17 ± 3 mm, p = 0.790).
Conclusions: Enlarged MLs could reverse accompanied by LV reverse remodeling. This study provided the other facet of ML plasticity adaptive to mechanical stretching.
Keywords: Recent-onset dilated cardiomyopathyreverse remodelingmitral leafletsleft ventricular
References
- Kang Yu, Chen C, Chen X, et al. Pattern of Mitral Leaflet Elongation and Its Association With Functional Mitral Regurgitation in Nonischemic Dilated Cardiomyopathy. Am J Cardiol. 2016; 118(7): 1069–1073.
- Chaput M, Handschumacher MD, Tournoux F, et al. Mitral leaflet adaptation to ventricular remodeling: occurrence and adequacy in patients with functional mitral regurgitation. Circulation. 2008; 118(8): 845–852.
- Beaudoin J, Dal-Bianco JP, Aikawa E, et al. Mitral Leaflet Changes Following Myocardial Infarction: Clinical Evidence for Maladaptive Valvular Remodeling. Circ Cardiovasc Imaging. 2017; 10(11).
- Yoshida S, Fukushima S, Miyagawa S, et al. The Adaptive Remodeling of the Anterior Mitral Leaflet and Chordae Tendineae Is Associated with Mitral Valve Function in Advanced Ischemic and Nonischemic Dilated Cardiomyopathy. International Heart Journal. 2018; 59(5): 959–967.
- Dal-Bianco JP, Levine RA, Hung J. Mitral Regurgitation Postinfarction: The Mitral Valve Adapts to the Times. Circ Cardiovasc Imaging. 2020; 13(12): e012130.
- Marsit O, Clavel MA, Côté-Laroche C, et al. Attenuated Mitral Leaflet Enlargement Contributes to Functional Mitral Regurgitation After Myocardial Infarction. J Am Coll Cardiol. 2020; 75(4): 395–405.
- Hirasawa K, Namazi F, Milhorini Pio S, et al. Insufficient Mitral Leaflet Remodeling in Relation to Annular Dilation and Risk of Residual Mitral Regurgitation After MitraClip Implantation. JACC Cardiovasc Imaging. 2021; 14(4): 756–765.
- Nishino S, Watanabe N, Gi T, et al. Longitudinal Evaluation of Mitral Valve Leaflet Remodeling After Acute Myocardial Infarction: Serial Quantitation of Valve Geometry Using Real-Time 3-Dimensional Echocardiography. Circ Cardiovasc Imaging. 2020; 13(12): e011396.
- Beaudoin J, Handschumacher MD, Zeng X, et al. Mitral valve enlargement in chronic aortic regurgitation as a compensatory mechanism to prevent functional mitral regurgitation in the dilated left ventricle. J Am Coll Cardiol. 2013; 61(17): 1809–1816.
- Takada H, Tanaka H, Yokota S, et al. Association of Relatively Short Posterior Mitral Leaflet With Mitral Regurgitation in Patients With Atrial Fibrillation. Circ J. 2019; 83(11): 2312–2319.
- Richardson P, McKenna W, Bristow M, et al. Report of the 1995 World Health Organization/International Society and Federation of Cardiology Task Force on the Definition and Classification of cardiomyopathies. Circulation. 1996; 93(5): 841–842.
- Pinto YM, Elliott PM, Arbustini E, et al. Proposal for a revised definition of dilated cardiomyopathy, hypokinetic non-dilated cardiomyopathy, and its implications for clinical practice: a position statement of the ESC working group on myocardial and pericardial diseases. Eur Heart J. 2016; 37(23): 1850–1858.
- Dudzinski DM, Hung J. Echocardiographic assessment of ischemic mitral regurgitation. Cardiovasc Ultrasound. 2014; 12: 46.
- Grande-Allen KJ, Borowski AG, Troughton RW, et al. Apparently normal mitral valves in patients with heart failure demonstrate biochemical and structural derangements: an extracellular matrix and echocardiographic study. J Am Coll Cardiol. 2005; 45(1): 54–61.
- Kruithof BPT, Paardekooper L, Hiemstra YL, et al. Stress-induced remodelling of the mitral valve: a model for leaflet thickening and superimposed tissue formation in mitral valve disease. Cardiovasc Res. 2020; 116(5): 931–943.
- Stephens EH, Nguyen TC, Itoh A, et al. The effects of mitral regurgitation alone are sufficient for leaflet remodeling. Circulation. 2008; 118(14 Suppl): S243–S249.
- Dal-Bianco JP, Aikawa E, Bischoff J, et al. Active adaptation of the tethered mitral valve: insights into a compensatory mechanism for functional mitral regurgitation. Circulation. 2009; 120(4): 334–342.
- Dal-Bianco JP, Aikawa E, Bischoff J, et al. Leducq Transatlantic Mitral Network. Myocardial Infarction Alters Adaptation of the Tethered Mitral Valve. J Am Coll Cardiol. 2016; 67(3): 275–287.
- Timek TA, Lai DT, Dagum P, et al. Mitral leaflet remodeling in dilated cardiomyopathy. Circulation. 2006; 114(1 Suppl): I518–I523.
- Nishino S, Watanabe N, Ashikaga K, et al. Reverse Remodeling of the Mitral Valve Complex After Radiofrequency Catheter Ablation for Atrial Fibrillation: A Serial 3-Dimensional Echocardiographic Study. Circ Cardiovasc Imaging. 2019; 12(10): e009317.
- Deferm S, Bertrand PB, Verbrugge FH, et al. Atrial Functional Mitral Regurgitation: JACC Review Topic of the Week. J Am Coll Cardiol. 2019; 73(19): 2465–2476.
- Johnson TM, Lowe L, Brown MD, et al. Histology and physiology of tissue expansion. J Dermatol Surg Oncol. 1993; 19(12): 1074–1078.
- Agrawal K, Agrawal S. Tissue regeneration during tissue expansion and choosing an expander. Indian J Plast Surg. 2012; 45(1): 7–15.
- May-Newman K, Yin FC. Biaxial mechanical behavior of excised porcine mitral valve leaflets. Am J Physiol. 1995; 269(4 Pt 2): H1319–H1327.
- Gunning GM, Murphy BP. Determination of the tensile mechanical properties of the segmented mitral valve annulus. J Biomech. 2014; 47(2): 334–340.
- El-Tallawi KC, Zhang P, Azencott R, et al. Mitral Valve Remodeling and Strain in Secondary Mitral Regurgitation: Comparison With Primary Regurgitation and Normal Valves. JACC Cardiovasc Imaging. 2021; 14(4): 782–793.
- Layoun H, Mentias A, Kanaan C, et al. Differences in patterns of progression of secondary mitral regurgitation. Eur Heart J Cardiovasc Imaging. 2023; 24(2): 223–231.
