LV mechanics in MR
Research type
Research Study
Full title
Determine Optimal Intervention Time Cut-Off for Degenerative Mitral Regurgitation by Left Ventricle Mechanics.
IRAS ID
231267
Contact name
Sanjeev Bhattacharyya
Contact email
Sponsor organisation
Barts Health NHS Trust
Duration of Study in the UK
3 years, 0 months, 1 days
Research summary
Summary of Research
The mitral valve is one of four valves found in the heart and sits between the lower heart chamber (left ventricle) and the upper heart chamber (left atrium). The mitral valve opens to allow blood to pass from the left atrium to left ventricle, and closes during contraction, to prevent backflow. Under some circumstances the mitral valve does not close probably. As result, blood leaks back through the mitral valve to the atrium during contraction. This is known as mitral regurgitation.\n \nUsually no treatment is required whilst you have mild mitral regurgitation with no symptoms and the heart function is normal. You will however, need to have regular check-ups by your heart specialist to monitor your case and the development of symptoms at regular intervals. Regular heart scans (echocardiograms) are usually arranged to monitor the severity of regurgitation and the heart function. \n\nIf you have moderate to severe mitral regurgitation with symptoms, you may need surgery to repair or replace the valve. The timing of mitral surgery has remained controversial because symptoms can remain absent or minimal despite severe regurgitation. Post-operative outcome among asymptomatic MR patient is poorly defined. The preoperative LV function assessment contributes a major role in predicting postoperative outcome. Despite, current guidelines recommend valve replacement/repair in the presence of symptoms or reduced LV ejection fraction, LVEF imperfect marker of post-operative myocardial function and survival. LV mechanics is a recent advance technique. It promises to be more reliable for myocardial performance to predict a better outcome and detect suboptimal cardiac dysfunction. \n\nIn this research study we investigate mitral regurgitation patients with echocardiography parameters to determine whether LV mechanics help to predict subclinical abnormalities and to establish the optimal timing for mitral valve surgery. \n
Summary of Results
Current guidelines recommend patients with a severely leaking mitral valve should undergo valve surgery if they have symptoms e.g shortness of breath. We found a proportion of patients with a leaking mitral valve did not report symptoms of shortness of breath during day to day activities actually became short of breath when they performed an exercise test using an exercise bicycle. Therefore, exercise testing maybe useful to determine whether a patient is truly asymptomatic or not. We also found patients with an elevated pressure in the heart at rest were more likely become short of breath during exercise. Therefore, the finding of increased pressure in the heart at rest may be useful to identify which patients should undergo exercise testing.
Current guidelines suggest patients with a severely leaking mitral valve should be referred for valve surgery if their heart is enlarged. The current method of measuring the size of the heart is the width/diameter of the heart. We found that measuring the volume of the heart was a better method to assess the heart as it predicted outcomes better.
REC name
South West - Central Bristol Research Ethics Committee
REC reference
17/SW/0237
Date of REC Opinion
19 Oct 2017
REC opinion
Further Information Favourable Opinion