Impact of left ventricular diastolic function on exercise capacity in patients with chronic mitral regurgitation: An exercise echocardiography study

Abstract

SummaryBackground: Mitral regurgitation (MR) is known as one of the most frequent causes of heart failure and sudden death. In spite of increasing prevalence of MR, there have been no available data on cardiac determinants of exercise capacity in patients with chronic MR.Hypothesis: This study aimed to investigate cardiac determinants of exercise capacity in patients with chronic MR.Methods: We consecutively enrolled 32 patients (11 men, mean age: 44 ± 14 years) who had greater than moderate MR with normal left ventricular (LV) systolic function (LV ejection fraction > 50%). Conventional echocardiographic indices and parameters measured by Doppler tissue imaging at septal side of mitral annulus were obtained before exercise. Mitral regurgitation fraction, forward stroke volume, pulmonary venous flow velocities, and systolic pulmonary artery pressure (sPAP) were also obtained with standard methods.Results: Left ventricular ejection fraction was 61 ± 6% and MR fraction was 48 ± 13%. All patients finished a symptomlimited treadmill exercise test with a peak heart rate of > 85% of predicted maximum heart rate. Mean exercise time was 9.95 ± 2.17 min, corresponding to 11 ± 2 metabolic equivalents. Among pre-exercise echocardiographic variables, only early diastolic mitral annulus velocity (E') and pulmonary venous reversal flow velocity (PVa) showed a significant corre-

Cardiopulmonary Exercise Testing Determination of Functional Capacity in Mitral Regurgitation

“…Indeed, FC is affected by LV characteristics, but not by LV systolic function, as all end-systolic LV indices showed no association to FC. Conversely, diastolic function is a major FC determinant (10,11,19), now shown to also strongly influence FC in organic MR (7). High E/E= ratio marks diastolic dysfunction with higher LV filling pressures (9,20) independent of MR (21).…”

Comparison of classifications for heart failure in children undergoing valvular surgery

“…16,17 It is well known that functional capacity of patients with chronic valvulopathy is dependant on diastolic function and a careful interpretation of echocardiographic measurements of heart function in those patients is required. 18 Similarly, recent studies analyzing right ventricle contractile function in children with heart failure secondary to pulmonary hypertension and congenital heart disease resulting in right ventricle pressure/volume overload or after corrected tetralogy of Fallot, failed to demonstrate a correlation between brain natriuretic peptide and ejection fraction. [19][20][21] Use of troponin to identify overt or underlying ventricular dysfunction has been well described in numerous conditions such as in acute myocardial infarction, heart failure, and septic shock and during multiorgan failure.…”

Relationship between exercise capacity and cardiac diastolic function assessed by time–volume curve from 16-frame gated myocardial perfusion SPECT

“…Later, Skaluba and Litwin indicated an association between tissue Doppler diastolic parameter E/Ea and exercise capacity in 121 patients without evidence of ischemic heart disease [16]. Kim et al [17] reported a potential role of LV diastolic function as a determinant of exercise capacity in 32 patients with mitral regurgitation. Furthermore, Wong et al [18] reported that LV diastolic function can predict exercise limitation in 119 patients with normal EF.…”

“…However, previous studies suggest that LV diastolic function before stress can predict exercise capacity in individuals with non-ischemic heart disease. Kim et al [17] demonstrated that pre-exercise diastolic function showed a significant correlation with exercise duration in patients with mitral regurgitation using echocardiography. Grewal et al also documented that the grade of diastolic function was strongly associated with a decreased exercise capacity in non-ischemic patients [19].…”

“…Numerous studies have suggested an association between LV diastolic function and exercise capacity [15][16][17][18]. Okura et al [15] showed a significant correlation between Doppler-derived LV diastolic indexes and exercise capacity in 160 healthy individuals.…”