• Christos G Mihos, Orlando Santana, Evin Yucel, Romain Capoulade, Gaurav A Upadhyay, Mary P Orencole, Jagmeet P Singh, and Michael H Picard.
• Echocardiography Laboratory, Division of Cardiology, Mount Sinai Heart Institute, Columbia University, Miami Beach, Florida.
• Echocardiography. 2019 Aug 1; 36 (8): 1450-1458.

BackgroundSecondary mitral regurgitation (MR) is common in patients with left bundle branch block (LBBB) undergoing cardiac resynchronization therapy (CRT). We aimed to define CRT effects on left ventricular (LV) and mitral valve (MV) geometry, and their correlation with MR severity.MethodsForty-one patients with LBBB and ≥mild secondary MR underwent CRT between 2009 and 2012, and had baseline and follow-up echocardiograms available. Repeated measure and linear regression analyses were performed to assess for changes in MV and LV geometry and MR severity, and associations with follow-up MR grade.ResultsThe mean age and baseline QRS duration were 65.5 ± 14.9 years and 160 ± 24 ms. At a mean follow-up of 2.6 ± 1.8 years, there was an increase in LV ejection fraction and reductions in LV end-systolic volume index, MR grade, and end-systolic interpapillary muscle distance (P < .05 for all). Linear correlations were observed between follow-up MR grade and baseline MV tenting height (r = .44), left atrial volume index (r = .41), LV end-systolic volume index (r = .4), MV tenting area (r = .38), LV ejection fraction (r = -.34), and end-systolic interpapillary muscle distance (r = .34) (P < .05 for all). Multiple regression analysis revealed associations between follow-up MR grade and baseline MV tenting height (β/mm = 0.42, P = .006) and left atrial volume index (β/mL/m2  = 0.4, P = .008), independent of QRS duration (β/ms=-0.07; P = 0.6) and nonischemic cardiomyopathy (β = -0.34, P = .02).ConclusionsCardiac resynchronization therapy in patients with LBBB and secondary MR results in LV and MV geometric reverse remodeling and decreases MR severity. Extent of baseline MV tethering is independently associated with persistent MR at follow-up.© 2019 Wiley Periodicals, Inc.

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