Effect of exercise on valvular resistance in patients with mitral stenosis

Voelker, Wolfram; A, Berner; Med, Cand; Regele, B.; Schmid, M.; Dittamann, Herbert; Stötzer, Tilmann; Haase, Karl K.; Baumbach, Andreas; Karsch, Karl R.

doi:10.1016/0735-1097(93)90190-c

Cited by 28 publications

(12 citation statements)

References 20 publications

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“…Our study found that the mean transmitral pressure gradient increased significantly from baseline to peak in both groups, Voelker et al . and Grimaldi et al .…”

Section: Discussionsupporting

confidence: 70%

Value of the Mitral Valve Resistance in Evaluation of Symptomatic Patients with Mild and Moderate Mitral Stenosis – A Dobutamine Stress Echocardiographic Study

2013

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“…Our study found that the mean transmitral pressure gradient increased significantly from baseline to peak in both groups, Voelker et al . and Grimaldi et al .…”

Section: Discussionsupporting

confidence: 70%

Value of the Mitral Valve Resistance in Evaluation of Symptomatic Patients with Mild and Moderate Mitral Stenosis – A Dobutamine Stress Echocardiographic Study

2013

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“…First, the increase in TMG during exercise is more attenuated in RMA patients than in patients with similar resting hemodynamics but with a more fixed orifice, as seen in organic mitral stenosis (30,31) and mechanical MVR (32). When describing and grading the degree of functional stenosis after RMA on the basis of resting data alone, it is important to realize the possible dynamic behavior of the EOA, especially in patients with beneficial LV remodeling.…”

Section: Discussionmentioning

confidence: 99%

Mitral Valve Area During Exercise After Restrictive Mitral Valve Annuloplasty

Bertrand

Verbrugge

Verhaert

et al. 2015

Journal of the American College of Cardiology

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BACKGROUND Restrictive mitral valve annuloplasty (RMA) for secondary mitral regurgitation might cause functional mitral stenosis, yet its clinical impact and underlying pathophysiological mechanisms remain debated. OBJECTIVES The purpose of our study was to assess the hemodynamic and clinical impact of effective orifice area (EOA) after RMA and its relationship with diastolic anterior leaflet (AL) tethering at rest and during exercise. METHODS Consecutive RMA patients (n = 39) underwent a symptom-limited supine bicycle exercise test with Doppler echocardiography and respiratory gas analysis. EOA, transmitral flow rate, mean transmitral gradient, and systolic pulmonary arterial pressure were assessed at different stages of exercise. AL opening angles were measured at rest and peak exercise. Mortality and heart failure readmission data were collected for at least 20 months after surgery. RESULTS EOA and AL opening angle were 1.5 ± 0.4 cm2 and 68 ± 10°, respectively, at rest (r = 0.4; p = 0.014). EOA increased significantly to 2.0 ± 0.5 cm2 at peak exercise (p < 0.001), showing an improved correlation with AL opening angle (r = 0.6; p < 0.001). Indexed EOA (EOAi) at peak exercise was an independent predictor of exercise capacity (maximal oxygen uptake, p = 0.004) and was independently associated with freedom from all-cause mortality or hospital admission for heart failure (p = 0.034). Patients with exercise EOAi <0.9 cm2/m2 (n = 14) compared with ≥0.9 cm2/m2 (n = 25) had a significantly worse outcome (p = 0.048). In multivariate analysis, AL opening angle at peak exercise (p = 0.037) was the strongest predictor of exercise EOAi. CONCLUSIONS In RMA patients, EOA increases during exercise despite fixed annular size. Diastolic AL tethering plays a key role in this dynamic process, with increasing AL opening during exercise being associated with higher exercise EOA. EOAi at peak exercise is a strong and independent predictor of exercise capacity and is associated with clinical outcome. Our findings stress the importance of maximizing AL opening by targeting the subvalvular apparatus in future repair algorithms for secondary mitral regurgitation.

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“…However, exercise wedge pressure, resting MVA, and gradients do not strictly correlate with exercise capacity and symptoms due to flow dependence properties of the mitral valve and PAP estimations [6,7,[19][20][21]. It is already recognized that exercise Doppler can help to refine the judgment about the hemodynamic severity of the MS [6,8,22].…”

Section: Hemodynamic Implications Of Impaired Right Ventricular Contrmentioning

confidence: 91%

Right ventricular contractile reserve in mitral stenosis: Implications on hemodynamic burden and clinical outcome

Sade

Özin

Ulus

et al. 2009

International Journal of Cardiology

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Effect of exercise on valvular resistance in patients with mitral stenosis

Cited by 28 publications

References 20 publications

Value of the Mitral Valve Resistance in Evaluation of Symptomatic Patients with Mild and Moderate Mitral Stenosis – A Dobutamine Stress Echocardiographic Study

Value of the Mitral Valve Resistance in Evaluation of Symptomatic Patients with Mild and Moderate Mitral Stenosis – A Dobutamine Stress Echocardiographic Study

Mitral Valve Area During Exercise After Restrictive Mitral Valve Annuloplasty

Right ventricular contractile reserve in mitral stenosis: Implications on hemodynamic burden and clinical outcome

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