Magnetic resonance imaging assessment of reverse left ventricular remodeling late after restrictive mitral annuloplasty in early stages of dilated cardiomyopathy.

OBJECTIVE: Magnetic resonance imaging was used to evaluate left ventricular reverse remodeling at long-term follow-up (3-4 years) after restrictive mitral annuloplasty in patients with early stages of nonischemic, dilated cardiomyopathy, and severe mitral regurgitation.

METHODS: Twenty-two selected patients (eligible to undergo magnetic resonance imaging) with mild to moderate heart failure (mean New York Heart Association class 2.2 +/- 0.4), dilated cardiomyopathy (left ventricular ejection fraction 37% +/- 5%, left ventricular end-diastolic volume 215 +/- 34 mL), and severe mitral regurgitation (grade 3-4+) underwent restrictive mitral annuloplasty. Magnetic resonance imaging was performed 1 week before surgery and repeated after 3 to 4 years.

RESULTS: There was no hospital mortality or major morbidity. Two patients died during follow-up (9%), and 2 patients could not undergo repeat magnetic resonance imaging because of comorbidity. New York Heart Association class improved from 2.2 +/- 0.4 to 1.2 +/- 0.4 (P < .05). Mitral regurgitation was minimal at late echocardiographic follow-up. There were significant decreases in indexed (to body surface area) left atrial end-systolic volume (from 84 +/- 20 mL/m(2) to 68 +/- 12 mL/m(2), P < .01), left ventricular end-systolic volume (from 42 +/- 14 mL/m(2) to 31 +/- 12 mL/m(2), P < .01), left ventricular end-diastolic volume (from 110 +/- 18 mL/m(2) to 80 +/- 17 mL/m(2), P < .01), and left ventricular mass (from 76 +/- 21 g/m(2) to 66 +/- 12 g/m(2), P = .03). Forward left ventricular ejection fraction improved from 37% +/- 5% to 55% +/- 10% (P < .01). Indexed left atrial end-diastolic volume did not show a significant decrease (from 48 +/- 16 mL/m(2) to 44 +/- 10 mL/m(2), P = .15).

CONCLUSION: Magnetic resonance imaging confirms sustained significant reverse left atrial and ventricular remodeling at late (3-4 years) follow-up in patients with nonischemic, dilated cardiomyopathy, and mild to moderate heart failure after restrictive mitral annuloplasty.