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Dilated Cardiomyopathy
Published in Andreas P. Kalogeropoulos, Hal A. Skopicki, Javed Butler, Heart Failure, 2023
Marco Merlo, Alessia Paldino, Giulia De Angelis, Gianfranco Sinagra
Two-dimensional Doppler echocardiography is still the most important tool in the assessment of DCM.53 In addition to LV systolic function and size, a complete evaluation is warranted. The presence and severity of functional mitral regurgitation provide important information for management and prognosis.54 Left ventricular diastolic function should be systematically assessed for estimation of left ventricular filling pressures and identification of restrictive filling pattern.55,56 The right ventricle, along with estimation of pulmonary arterial pressure, is also essential in risk stratification in DCM.57
Mitral Regurgitation
Published in K. Gupta, P. Carmichael, A. Zumla, 100 Short Cases for the MRCP, 2020
K. Gupta, P. Carmichael, A. Zumla
Mitral regurgitation is characterized by regurgitation of blood from the left ventricle into the left atrium and pulmonary veins during systole. Acute mitral regurgitation can be a potentially catastrophic effect which may develop from sudden rupture of the chordae tendineae, papillary muscle or the valvular leaflet. A common cause is infective endocarditis.
Acute coronary syndrome with haemodynamic instability
Published in K Sarat Chandra, AJ Swamy, Acute Coronary Syndromes, 2020
Davinder Singh Chadha, Keshavamurthy Ganapathy Bhat
Coronary artery bypass surgery: The majority of patients with CS after MI have significant left main or three vessel disease (16% and 53%, respectively, in the SHOCK trial registry) [34]. In such patients, the ability to achieve complete revascularisation makes CABG a potentially critical therapeutic strategy. A surgical approach also permits the correction of concomitant severe mitral regurgitation, which is often present. Pooled data on 370 patients in 22 studies revealed an in-hospital mortality rate of 36% when CABG was performed during the hospitalisation for acute MI with CS [38]. Despite this benefit, CABG is underutilised in the community setting.
Recent advances in patient selection and devices for transcatheter edge-to-edge mitral valve repair in heart failure
Published in Expert Review of Medical Devices, 2020
Martin Orban, Enzo Lüsebrink, Daniel Braun, Thomas J. Stocker, Erik Bagaev, Christian Hagl, Michael Näbauer, Steffen Massberg, Mathias Orban, Jörg Hausleiter
Concomitant secondary mitral regurgitation is not only a side-effect of chronic left ventricular heart failure. It is a disease on its own and its (interventional) treatment improves prognosis which was one of the most interesting and controversial questions in the field of treatment in heart failure patients in the past and was recently answered by the results of the COAPT trial. In light of the different results of MITRA-FR and COAPT trial, it becomes clearer which heart failure patient with concomitant MR profits from TMVR in terms of prognosis or in whom TMVR might be used as symptomatic therapy when guideline-directed medical therapy on highest tolerable dosage is insufficient and left ventricular assist device implantation or heart transplantation are not an option. Heart failure patients with more severe MR and less dilated left ventricles – according to COAPT criteria – show improved prognosis and reduced rate of hospitalizations after treatment with TMVR. But also ‘hypo-proportionate’ MR patients might profit symptomatically and in terms of functional capacity according to a small subgroup analysis of the COAPT trial itself. If the controversially discussed principle of MR-proportionality can prove its validity or will disprove in large ‘real world’ registries is one exciting question for further investigations.
Parameters affecting outcome of paediatric cardiomyopathies in the intensive care unit: experience of an Egyptian tertiary centre over 7 years
Published in Libyan Journal of Medicine, 2020
Alaa A. Sobeih, Sonia A. El-Saiedi, Noha S. Abdel Khalek, Shereen A. Attia, Baher M. Hanna
Echocardiographic measurements showed no statistical correlation with survival (Table 2): all studied echocardiographic parameters had poor predictive value, with areas under the ROC curves ranging from 0.52 to 0.60 and p-values >0.05. The degree of mitral regurgitation (MR) did not correlate with outcome: mild, moderate and severe MR was present in 59.4% (n = 41), 26.1% (n = 18), and 14.5% (n = 10) of survivors, respectively, and in 56.6% (n = 13), 21.7% (n = 5), and 21.7% (n = 5) of non-survivors, respectively. Even severe MR was not a statistically significant risk factor for mortality (odds ratio = 1.64, 95%CI = 0.52–5.21, p-value = 0.418). Moreover, an LV thrombus was documented in both survivors (7.2%, n = 5) and non-survivors (4.3%, n = 1) but had no statistically significant association with mortality (p > 0.05).
Cost-effectiveness analysis of percutaneous mitral valve repair with the MitraClip delivery system for patients with mitral regurgitation in Japan
Published in Journal of Medical Economics, 2019
Hiroyuki Sakamaki, Koichi Nakao, Takashi Matsumoto, Sachie Inoue
Mitral regurgitation (MR) occurs when the heart’s mitral valve leaflets do not coapt or close properly, allowing the backward flow of blood from the left ventricle (LV) into the left atrium (LA) during systole, decreasing forward flow into the aorta and the systemic circulation. There is inadequate coaptation of the mitral valve leaflets, resulting in regurgitation of blood from the LV into the LA during systole that leads to LV volume overload, reduction in LV afterload, and increase in LV pressure. Severe acute MR presents with cardiogenic shock secondary to pulmonary congestion and lower cardiac output associated with rapid increase in LV volume load. Severe chronic MR is asymptomatic for a while but, over time, LV dilatation occurs followed by remarkable pulmonary congestion and worsened LV ejection fraction (EF). The majority of patients present with chronic MR, and their quality of life (QOL) is worsened as they experience heart failure (HF) symptoms. If worsened, the condition can lead to chronic HF and ultimately, stroke, atrial fibrillation or sudden death.