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Functional heart restoration after mitral valvereplacement in patients with sinus rhythmand atrial fibrillation

Authors: Ivleva O.V. 1, Avdeeva M.V. 2

Company: 1Bakoulev National Medical Research Center for Cardiovascular Surgery of Ministry of Health of the Russian Federation, Rublevskoe shosse, 135, Moscow, 121552, Russian Federation;
2North-Western State Medical University named after I.I. Mechnikov of Ministry of Health of the Russian Federation, ulitsa Kirochnaya, 41, Saint-Petersburg, 191015, Russian Federation

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Type:  Heart rhythm disorders


DOI: https://doi.org/10.24022/1997-3187-2018-12-1-40-49

For citation: Ivleva O.V., Avdeeva M.V. Influence of mitral valve replacement on functional heart restoration in patients with sinus rhythm and atrial fibrillation. Creative Cardiology (Kreativnaya Kardiologiya). 2018; 12 (1): 40–9 (in Russ.). DOI: 10.24022/1997-3187-2018-12-1-40-49.

Received / Accepted:  02.08.2017/09.08.2017

Keywords: mitral valve replacement heart disease atrial fibrillation surgical treatment the sphericity index the integrated systolic heart-remodeling index myocardial stress

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Abstract

Objective. To assess the left ventricular (LV) remodeling process by echocardiography after mitral valve (MV) replacement in patients with sinus rhythm and chronic atrial fibrillation (AF).

Material and methods. We examined 48 patients (mean age: 46,4±7,5 years old); among them – with isolated mitral stenosis (n=10; 20,8%); with MV insufficiency (n=20; 41,7%); with combined MV lesion (n=18; 37,5%). The subgroups of patients with sinus rhythm and chronic AF were formed in each group. Echocardiographic parameters of cardiac remodeling were estimated in all patients before operation, in the early (10–14 days) and long-term postoperative period (mean – 8.7±1.2 months), such as: systolic and diastolic myocardial stress, the integrated systolic heart-remodeling index, the index of relative myocardial thickness, the sphericity index in systole.

Results. At 10–14 days after the operation, both in patients with mitral stenosis and in patients with mitral insufficiency, the type of the heart rhythm did not affect significantly parameters of LV geometric remodeling. In patients with combined MV lesion and sinus rhythm compared to AF diastolic myocardial stress (47.9±8.05 and 74.7±6.08 dyn/cm2, p<0.05) and systolic myocardial stress (75.6±7.6 and 105±6.8 dyn/cm2, p<0.05) were lower. In long-term follow-up in patients with mitral stenosis and mitral insufficiency, the type of the heart rhythm also did not influence significantly on changes of LV geometry. While patients with combined MV lesion and sinus rhythm compared to AF had lower LV sphericity index in systole (0.51±0.04 and 0.59±0.03 un., p<0.05) and systolic myocardial stress (86.4±9.9 and 102.1±6.3 dyn/cm2, p<0.05), which indicates that processes of reverse myocardial remodeling after MV replacement proceeds better in patients on sinus rhythm than AF.

Conclusion. After MV replacement the LV geometry is improved in the early and long-term follow-up period. These changes are more significant in patients with combined mitral valve lesion on sinus rhythm than on AF.

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About Authors

  • Ivleva Ol'ga Viktorovna, Cand. Med. Sc., Researcher, orcid.org/0000-0002-0447-4858;
  • Avdeeva Marina Vladimirovna, Dr Med. Sc., Associate Professor, orcid.org/0000-0002-4334-5434.

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery


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