Mitral regurgitation in heart failure: insights from CPET combined with exercise echocardiography

Bandera, Francesco; Generati, Greta; Pellegrino, Marta; Garatti, Andrea; Labate, Valentina; Alfonzetti, Eleonora; Gaeta, Maddalena; Castelvecchio, Serenella; Menicanti, Lorenzo; Guazzi, Marco

doi:10.1093/ehjci/jew096

Cited by 18 publications

(18 citation statements)

References 22 publications

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“…Similar results were found in HF patients undergoing stress exercise. LA strain impairment at rest and during exercise correlates well with the right ventricle–pulmonary haemodynamic uncoupling . Similarly, dynamic MR in HFrEF is a strong predictor of PH and an unfavourable ventilatory profile…”

Section: Discussionmentioning

confidence: 84%

“…LA strain impairment at rest and during exercise correlates well with the right ventricle-pulmonary haemodynamic uncoupling. 25 Similarly, dynamic MR in HFrEF is a strong predictor of PH and an unfavourable ventilatory profile. 26 The explanation of our results is linked to the above-mentioned adaptive process involving LA myocardium in the context of HF and MR, leading to reduced compliance and increased stiffness.…”

Section: Haemodynamic Interaction Between Mitral Regurgitation and Lementioning

confidence: 99%

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Mitral regurgitation, left atrial structural and functional remodelling and the effect on pulmonary haemodynamics

Rossi

Bergamini

Benfari

et al. 2019

European J of Heart Fail

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Aims To assess the association between mitral regurgitation (MR) and left atrial (LA) structural and functional remodelling and their effect on pulmonary haemodynamics. Methods and results Consecutive unselected patients undergoing comprehensive echocardiography were enrolled. Parameters of cardiac structure and function were obtained as well as mitral effective regurgitant orifice area (ERO) and estimation of pulmonary artery systolic pressure (PASP). Measures of LA structure [LA volume (LAV)] and function [peak atrial longitudinal strain (PALS), peak atrial contraction strain (PACS) and conduit strain (CS)] were also calculated. The study population included 102 patients (mean age 70 ± 14 years, 42% women), with a mean ejection fraction of 52 ± 13%. MR was classified as organic due to mitral valve prolapse in 14 patients (14%) and functional in 88 patients (86%). Mean ERO was 0.12 ± 0.12 cm2 and 86 patients (84%) had an ERO ≤0.2 cm2. ERO was significantly associated with worse measures of LA structure and function. Despite the low burden of MR, the association remained significant after adjusting for clinical and echocardiographic confounders (β: 3.7, P = 0.022 for LAV; β: −3.0, P = 0.003 for PALS; β: −1.8, P = 0.027 for PACS) and was significantly related with functional MR (P for interaction <0.001). ERO was also significantly associated with PASP, and measures of LA function (PALS and PACS) significantly modified this relationship (P for interaction <0.001). Conclusions Even a mild degree of MR contributes to LA remodelling and this relationship plays an active role in pulmonary circulation, suggesting a potential mechanism by which these parameters contribute to the development of heart failure.

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Section: Discussionmentioning

confidence: 84%

Section: Haemodynamic Interaction Between Mitral Regurgitation and Lementioning

confidence: 99%

Mitral regurgitation, left atrial structural and functional remodelling and the effect on pulmonary haemodynamics

Rossi

Bergamini

Benfari

et al. 2019

European J of Heart Fail

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“…Most of the patients with exercise increase in MR and sPAP stop their exercise because of dyspnea (65). The limitation in functional capacity is similar in patients with dynamic MR and PH to those with severe MR at rest (69). The best predictive cut-off value for the increase in sPAP associated with the outcome in patients with chronic ischemic LV systolic dysfunction is 21 mmHg (65).…”

Section: Exercise-induced Phmentioning

confidence: 99%

Pulmonary Hypertension in Aortic Stenosis and Mitral Regurgitation: Rest and Exercise Echocardiography Significance

Martinez

Bernard

Incarnato

et al. 2016

Progress in Cardiovascular Diseases

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“…15,16 The combination of cardiopulmonary exercise testing with exercise stress echocardiography is a valuable diagnostic tool and its clinical utility has been proven in the diagnostic evaluation of many cardiac diseases including heart failure with reduced, midrange or preserved LV EF; cardiomyopathies; pulmonary arterial hypertension; valvular heart disease and coronary artery disease. 13,14,17,18,36,[39][40][41][42] Furthermore, CPET-SE provides additional information in the case of patients without heart failure, but with unexplained exercise dyspnea.43,44 Exercise pulmonary hypertension due to mitral regurgitation or left ventricular dysfunction can also lead to reduced EC.37,41,42 Furthermore, elevated left ventricular filling pressure during exercise in patients with exercise intolerance and without diastolic dysfunction at rest can be identified by CPET-SE.40 Because resting LV EF is weakly correlated with exercise capacity, there is a need to clarify other parameters contributing to exercise performance including left and right ventricular contractile reserve, interventricular dependence, diastolic function, left atrial function as well as peripheral factors. 37,39,44 Limitations This study has several limitations.…”

Section: Combined Stress Echocardiography and Cardiopulmonary Exercismentioning

confidence: 99%

Combined Use of Stress Echocardiography and Cardiopulmonary Exercise Testing to Assess Exercise Intolerance after Acute Myocardial Infarction

Smarż¹,

Jaxa-Chamiec²,

Zaborska³

et al. 2020

Preprint

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Background: Exercise capacity (EC) after acute myocardial infarction (AMI) influences prognosis, but the causes of its reduction are complex and not sufficiently studied. Methods: We prospectively enrolled consecutive patients who underwent percutaneous coronary intervention for their first AMI with left ventricular ejection fraction (LV EF) >40% at least 4 weeks after AMI. We performed combined stress echocardiography and cardiopulmonary exercise testing (CPET-SE) using a semi-supine cycle ergometer to determine predictors of EC (peak oxygen uptake [VO2]). Results: Among 81 patients (70% male, mean age 58 ± 11 years), 40% had AMI with ST-segment elevation, and 60% non ST-segment elevation, LV EF was 57 ± 7%; wall motion score index, 1.18 (IQR 1.06 - 1.31); peak VO2, 19.5 ± 5.4 mL/kg/min. Multivariate analysis revealed that parameters at peak exercise: heart rate (β = 0.17, p < 0.001), stroke volume (β = 0.09, p < 0.001), and arteriovenous oxygen difference (A-VO2Diff, β = 93.51, p < 0.001) were independently positively correlated with peak VO2, with A-VO2Diff being its strongest contributor. Conclusions: In patients treated for AMI with normal/mildly reduced LV EF, EC is associated with peak peripheral oxygen extraction as well as peak heart rate and peak stroke volume. CPET-SE is a useful tool to evaluate decreased fitness in this group.

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Mitral regurgitation in heart failure: insights from CPET combined with exercise echocardiography

Cited by 18 publications

References 22 publications

Mitral regurgitation, left atrial structural and functional remodelling and the effect on pulmonary haemodynamics

Mitral regurgitation, left atrial structural and functional remodelling and the effect on pulmonary haemodynamics

Pulmonary Hypertension in Aortic Stenosis and Mitral Regurgitation: Rest and Exercise Echocardiography Significance

Combined Use of Stress Echocardiography and Cardiopulmonary Exercise Testing to Assess Exercise Intolerance after Acute Myocardial Infarction

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