Early Improvement of Functional Mitral Valve Regurgitation in Dilated Cardiomyopathy Patients

Functional mitral valve regurgitation (FMR) is the disease of the left ventricle. Mitral valve separates the left atrium from the left ventricle and opens to allow the blood flow through and then shuts once the left ventricle is loaded with blood. This process prevents back-flow of blood.

In functional mitral valve regurgitation (FMR) condition the left ventricle of the heart is distorted or enlarged. Dilation of the left ventricle displaces the papillary muscles that support the two valve leaflets and stretching the valve opening also known as annulus. This results in abnormal leaking of blood backwards from the left ventricle, through the mitral valve into the left atrium. Functional mitral valve regurgitation when left untreated can overload the heart and result in heart failure. Rate of survival is decreased in patients with mild mitral regurgitation.

Causes of functional mitral valve regurgitation include age, high blood pressure, cardiomyopathy, congenital heart defects, trauma and use of certain medications.

Functional Mitral Valve Regurgitation is a significant complication of end-stage cardiomyopathy.

The main goal of functional mitral regurgitation treatment is to slow or reverse ventricular remodelling, decrease the frequency of hospitalization for congestive heart failure, slow progression to advanced heart failure (time to transplant) and improve survival rate.

Davide Stolfo, MD and his team conducted a study to assess the clinical and prognostic effect of early functional mitral valve regurgitation improvement on outcome of idiopathic dilated cardiomyopathy (IDC) patients.

The term cardiomyopathy refers to the abnormality of heart muscle. In dilated cardiomyopathy or DCM the left ventricle gets dilated and can't pump blood as well as a healthy heart can. Dilated cardiomyopathy can be life-threatening for some people. DCM can contribute to heart failure, irregular heartbeats (arrhythmias), blood clots or sudden death (in few cases). Dilated cardiomyopathy affects people of all ages but most common between the ages 20 and 60 years. DCM also occurs in infants and children.

Signs and Symptoms of Idiopathic Dilated Cardiomyopathy:

a) Enlarged heart with pulmonary edema

b) Low pulse pressure

c) Signs of mitral and tricuspid regurgitation

470 patients with idiopathic dilated cardiomyopathy with available FMR data at baseline and after 6 ± 2 months from 1988 to 2009 were enrolled for the study. Based on the evolution of functional mitral valve regurgitation, patients were grouped into 3 categories

a) Stable absent-mild Functional Mitral Valve Regurgitation

b) Early Functional Mitral Valve Regurgitation improvement

c) Persistence/early development of moderate-severe Functional Mitral Valve Regurgitation

38% of the patients in the study had moderate-severe functional mitral valve regurgitation. Better survival rate was seen among patients with early functional mitral valve regurgitation improvement. 6 month follow up analysis revealed FMR improvement was associated with better prognosis.

Researchers concluded that idiopathic dilated cardiomyopathy patients who received optimal medical treatment, early improvement of FMR was frequent and emerged as a favorable independent prognostic factor.

Study co-authors include Marco Merlo, Bruno Pinamonti, Stefano Poli, Marta Gigli, Giulia Barbati, Enrico Fabris, Andrea Di Lenarda, Gianfranco Sinagra.

The study results are published in The American Journal of Cardiology.

Source: Medindia

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