Clinical Research
Valvular Heart Disease
Exercise-Induced Changes in Degenerative Mitral Regurgitation

https://doi.org/10.1016/j.jacc.2009.12.073Get rights and content
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Objectives

We sought to quantify exercise-induced changes in patients with degenerative mitral regurgitation (MR), to examine the relationship between exercise-induced changes in MR and in systolic pulmonary artery pressure (PAP), and to identify their potential impact on symptom-free survival.

Background

MR severity can change during exercise in patients with functional MR. Quantified changes in MR severity during exercise remain undetermined in patients with degenerative MR.

Methods

Resting and bicycle exercise Doppler-echocardiography were performed in 61 asymptomatic patients (age 62 ± 14 years) with moderate to severe degenerative MR (i.e., mitral valve prolapse or flail). Mitral regurgitation was quantified at rest and exercise with effective regurgitant orifice (ERO) area and regurgitant volume calculated with the proximal isovelocity surface area (EROP) and the quantitative Doppler (EROD) methods.

Results

At rest, EROPand ERODwere well-correlated (r = 0.87, p < 0.0001), but ERODwas larger than EROP(54 ± 21 mm2vs. 42 ± 24 mm2, p < 0.0001). During exercise, mean ERO and regurgitant volume markedly increased in 32% of patients by ≥10 mm2and ≥15 ml, respectively. There was good correlation between exercise EROPand EROD(r = 0.84, p < 0.0001). Changes in systolic PAP were correlated with changes in ERO and regurgitant volume (r = 0.59, p = 0.02 and r = 0.60, p = 0.02). Patients with a marked increase in regurgitant volume during exercise had lower symptom-free survival than those in whom MR decreased or remained unchanged (p = 0.0015).

Conclusions

Degenerative MR might be dynamic and increases during exercise in one-third of patients. Marked changes in MR severity are associated with exercise-induced changes in systolic PAP and reduced symptom-free survival.

Key Words

Doppler echocardiography
exercise
mitral regurgitation
valve

Abbreviations and Acronyms

ERO
effective regurgitant orifice
EROD
effective regurgitant orifice by quantitative Doppler
EROP
effective regurgitant orifice by proximal isovelocity surface area
LA
left atrial
LV
left ventricular
MR
mitral regurgitation
PAP
pulmonary artery pressure
PISA
proximal isovelocity surface area
TR
tricuspid regurgitation

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Continuing Medical Education (CME) is available for this article.

Dr. Magne was supported by a grant from the Fonds de la Recherche en Santé du Québec, Québec, Canada.