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Furthermore, using the total volume load instead of transvalvular MR volume improved the correlation with LV end-diastolic volume in patients with BD, supporting the authors concept that disproportionate LV remodeling in BD can be explained by the total volume load ( FIGURE 2 Impact at the Cellular and Molecular Level On a microscopic level, LV remodeling related to chronic LV volume overload is characterized by significant changes in the extracellular matrix, including alterations in collagen and matrix metalloproteinase expression ( Left Ventricular Remodeling Related to an Underlying Cardiomyopathy Another theory to explain LV remodeling in MVP, certainly when disproportionate to the degree of MR, is the existence of an underlying myocardial diseasea cardiomyopathy

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Clinical trials have demonstrated substantial glycemic control improvements and weight loss averaging 15-21% of body weight at higher doses