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Cardiac resynchronisation therapy reduces functional mitral regurgitation during dynamic exercise in patients with chronic heart failure: an acute echocardiographic study
  1. P-V Ennezat1,
  2. B Gal1,
  3. C Kouakam1,
  4. C Marquie1,
  5. T LeTourneau1,
  6. D Klug1,
  7. D Lacroix1,
  8. D Logeart2,
  9. A Cohen-Solal2,
  10. S Dennetière3,
  11. E Van Belle1,
  12. G Deklunder1,
  13. P Asseman1,
  14. P de Groote1,
  15. S Kacet1,
  16. T H LeJemtel4
  1. 1Cardiology Hospital, Lille, France
  2. 2Department of Cardiology, Lariboisière Hospital, Paris, France
  3. 3Department of Cardiology, Roubaix Hospital, France
  4. 4Department of Medicine, Tulane School of Medicine, New Orleans, Louisiana, USA
  1. Correspondence to:
    Dr P-V Ennezat
    Intensive Care Unit, Cardiology hospital, Bd Pr J Leclercq, 59037 Lille, France; ennezat{at}


Objectives: To assess non-invasively the acute effects of cardiac resynchronisation therapy (CRT) on functional mitral regurgitation (MR) at rest and during dynamic exercise.

Methods: 21 patients with left ventricular (LV) systolic dysfunction and functional MR at rest, treated with CRT, were studied. Each patient performed a symptom-limited maximal exercise with continuous two dimensional Doppler echocardiography twice. The first exercise was performed with CRT; the second exercise was performed without CRT. Mitral regurgitant flow volume (RV), effective regurgitant orifice area (ERO) and LV dP/dt were measured at rest and at peak exercise.

Results: CRT mildly reduced resting mitral ERO (mean 8 (SEM 2) v 11 (2) mm2 without CRT, p  =  0.02) and RV (13 (3) v 18 (3) ml without CRT, p  =  0.03). CRT attenuated the spontaneous increase in mitral ERO and RV during exercise (1 (1) v 9 (2) mm2, p  =  0.004 and 1 (1) v 8 (2) ml, p  =  0.004, respectively). CRT also significantly increased exercise-induced changes in LV dP/dt (140 (46) v 479 (112) mm Hg/s, p < 0.001).

Conclusion: Attenuation of functional MR, induced by an increase in LV contractility during dynamic exercise, may contribute to the beneficial clinical outcome of CRT in patients with chronic heart failure and LV asynchrony.

  • CHF, chronic heart failure
  • CRT, cardiac resynchronisation therapy
  • ERO, effective regurgitant orifice area
  • LV, left ventricular
  • MR, mitral regurgitation
  • RTVI, regurgitant time–velocity integral
  • RV, regurgitant flow volume
  • cardiac resynchronisation therapy
  • echocardiography
  • exercise
  • mitral regurgitation

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  • Published Online First 30 December 2005