Experimental studies on ischemic mitral regurgitation
Myocardial infarction and heart failure are serious outcomes of the atherosclerotic process.
Effective treatment with coronary stent implantation has significantly reduced 30 days mortality, however, late complications as mitral regurgitation and heart failure are expected to increase in the future. Several mechanisms are involved, including displacement of papillary muscles with tethering and leaflet restriction. The left ventricle is challenged by increased volume load causing further remodeling with dilatation and transformation of mitral annulus geometry.
Clinical trials fail to show improved survival after surgical interventions in patients with ischemic mitral regurgitation. This can be due to: 1) Improper interventions 2) Too late interventions 3) Lack of methods selecting those patients that might benefit from treatment. There is paucity of data prospectively describing the remodeling process, and importantly, to what extent the remodeling is accelerated at the time the regurgitation is significant.
A novel 3D holographic display has been developed and enables quantification of mitral valve apparatus by 3D echocardiography .
The primary objective is to explore mechanisms of mitral regurgitation after acute myocardial infarction by 3D echo with special emphasis on the remodeling process of the left ventricle and mitral valve apparatus. Secondly, identify markers predicting patients at risk and test the hypothesis that early percutaneous mitral annuloplasty (Cardioband™) may prevent further remodeling and progression of heart failure in ischemic mitral regurgitation. Finally, data from experiments will be implemented in a finite element model of the mitral valve apparatus, enabling simulations of predicted results after cardioband deployment.
The project is funded by the Trond Mohn Foundation (TMF), Haukeland University Hospital and the Western Norway Regional Health Authority