Observations suggesting a high incidence of exercise-induced severe mitral regurgitation in patients with mild rheumatic mitral valve disease at rest

Tischler, Marc D.; Battle, Robert W.; Saha, Madhumita; Niggel, Joelyn; LeWinter, Martin M.

doi:10.1016/0735-1097(94)00359-x

Cited by 57 publications

(21 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In symptomatic patients in whom the severity of MR is estimated to be only mild at rest, exercise echocardiography may be useful in elucidating the cause of symptoms by determining whether the severity of MR increases or pulmonary arterial hypertension develops during exercise (54). It is noteworthy that the data supporting this concept were derived in patients with rheumatic MR, and the data supporting this application for degenerative MR are limited.…”

Section: Mitral Regurgitation (Mr)mentioning

confidence: 90%

The Emerging Role of Exercise Testing and Stress Echocardiography in Valvular Heart Disease

Picaño

Pîbarot

Lancellotti

et al. 2009

Journal of the American College of Cardiology

211

131

View full text Add to dashboard Cite

Exercise testing has an established role in the evaluation of patients with valvular heart disease and can aid clinical decision making. Because symptoms may develop slowly and indolently in chronic valve diseases and are often not recognized by patients and their physicians, the symptomatic, blood pressure, and electrocardiographic responses to exercise can help identify patients who would benefit from early valve repair or replacement. In addition, stress echocardiography has emerged as an important component of stress testing in patients with valvular heart disease, with relevant established and potential applications. Stress echocardiography has the advantages of its wide availability, low cost, and versatility for the assessment of disease severity. The versatile applications of stress echocardiography can be tailored to the individual patient with aortic or mitral valve disease , both before and after valve replacement or repair. Hence, exercise-induced changes in valve hemodynam-ics, ventricular function, and pulmonary artery pressure, together with exercise capacity and symptomatic responses to exercise, provide the clinician with diagnostic and prognostic information that can contribute to subsequent clinical decisions. Nevertheless, there is a lack of convincing evidence that the results of stress echo-cardiography lead to clinical decisions that result in better outcomes, and therefore large-scale prospective ran-domized studies focusing on patient outcomes are needed in the future. (J Am

show abstract

Section: Mitral Regurgitation (Mr)mentioning

confidence: 90%

The Emerging Role of Exercise Testing and Stress Echocardiography in Valvular Heart Disease

Picaño

Pîbarot

Lancellotti

et al. 2009

Journal of the American College of Cardiology

211

131

View full text Add to dashboard Cite

show abstract

“…8,12 Of note, MR severity increases by one grade (from moderate to severe, by measuring the proximal isovelocity surface area) in 30% of all patients during exercise. 8,34 This phenomenon is often associ ated with exercise induced pulmonary hypertension. 10 Patients with a marked increase in regurgitant volume or who develop pulmonary hypertension (defined as sys tolic pulmonary artery pressure >60 mmHg) during exer cise have lower symptom free survival than those who do not experience significant changes in MR and systolic pulmonary artery pressure during exercise.…”

Section: Fluctuating Degenerative Primary Mrmentioning

confidence: 99%

Therapeutic decision-making for patients with fluctuating mitral regurgitation

2015

View full text Add to dashboard Cite

| Mitral regurgitation (MR) is a common, progressive, and difficult-to-manage disease. MR is dynamic in nature, with physiological fluctuations occurring in response to various stimuli such as exercise and ischaemia, which can precipitate the development of symptoms and subsequent cardiac events. In both chronic primary and secondary MR, the dynamic behaviour of MR can be reliably examined during stress echocardiography. Dynamic fluctuation of MR can also have prognostic value; patients with a marked increase in regurgitant volume or who exhibit increased systolic pulmonary artery pressure during exercise have lower symptom-free survival than those who do not experience significant changes in MR and systolic pulmonary artery pressure during exercise. Identifying patients who have dynamic MR, and understanding the mechanisms underlying the condition, can potentially influence revascularization strategies (such as the surgical restoration of coronary blood flow) and interventional treatment (including cardiac resynchronization therapy and new approaches targeted to the mitral valve).

show abstract

“…Direct rheumatic involvement of the tricuspid valve usually produces tricuspid stenosis as well as regurgitation; severity of either may necessitate intervention. Successful detection of TVR preoperatively may require dynamic physiologic assessment, as several investigations have shown that exercise may induce significant pulmonary hypertension not detected at rest [8,9].…”

Section: Opinion Statementmentioning

confidence: 99%

Tricuspid valvular regurgitation

Raman

Wooley

2001

Curr Treat Options Cardio Med

View full text Add to dashboard Cite

Precision in diagnosis always precedes rational therapy. Categorizing tricuspid valvular regurgitation (TVR) as simply organic versus functional limits one's understanding of the complexity of the lesion, and may lead to inadequate therapy. Rather, treatment of TVR should begin with an assessment of the affected components of the tricuspid valve complex (TVC). From this assessment, one constructs an appropriate medical or surgical strategy that seeks to reduce symptoms, restore right heart function, and alter the course of the underlying disease process.

show abstract

Observations suggesting a high incidence of exercise-induced severe mitral regurgitation in patients with mild rheumatic mitral valve disease at rest

Cited by 57 publications

References 15 publications

The Emerging Role of Exercise Testing and Stress Echocardiography in Valvular Heart Disease

The Emerging Role of Exercise Testing and Stress Echocardiography in Valvular Heart Disease

Therapeutic decision-making for patients with fluctuating mitral regurgitation

Tricuspid valvular regurgitation

Contact Info

Product

Resources

About