Reply Primum Non Nocere: First Do No Harm

Discussion section, the strong correlation shown in Figure 4A would not be possible if variability of afterload was an important consideration.3.If aortic regurgitation were underestimated by MRI, it would lead to an overestimation of mitral regurgitant volume, not an underestimation.4.We do not believe our study shows that pre-surgical left ventricular (LV) volumes predict recovery of LV end-diastolic volume (EDV) post-surgery. For example, in Table 4, patient 29 had mild mitral regurgitation (MR) and an end-diastolic diameter (EDD) of 6.2 cm, whereas patient 38 had severe MR and an EDD of 5.3 cm. Our study shows that MR volume (determined as the difference between LV stroke volume and forward flow) strongly correlates with the decrease in LVEDV following surgery (Figure 4A).5.We do not believe studies showing reverse remodeling following percutaneous repair indicate that echocardiography selects appropriate surgical candidates. The bar graph shown in our Central Illustration confirms that echocardiography can be used to predict the degree of remodeling. However, it does a much poorer job than MRI. As a result, many patients are incorrectly classified as having severe MR, potentially leading to inappropriate surgical intervention (Figure 3).6.We do not believe any amount of negative remodeling following surgery indicates an appropriate surgical candidate. MRI-derived ventricular volumes increase even in patients with mild MR (2). The fact that MRI detects negative remod...
Source: Journal of the American College of Cardiology - Category: Cardiology Source Type: research