Quantitation of functional mitral regurgitation during bicycle exercise in patients with heart failure

Lebrun, Frédéric; Lancellotti, Patrizio; Piérard, Luc

doi:10.1016/s0735-1097(01)01605-9

Cited by 132 publications

(66 citation statements)

References 34 publications

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“…The quantitation of MR was performed by the quantitative Doppler method using mitral and aortic stroke volumes and the proximal isovelocity surface area method, as previously described. 7,8 The results of these 2 methods were averaged, allowing the calculation of regurgitant volume and the effective regurgitant orifice (ERO). Left ventricular end-diastolic and end-systolic volumes and ejection fractions were measured by the bi-apical Simpson disk method.…”

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confidence: 99%

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Effect of cardiac resynchronization therapy on functional mitral regurgitation in heart failure

Lancellotti¹,

Mélon²,

Sakalihasan

et al. 2004

The American Journal of Cardiology

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102

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C ardiac resynchronization therapy (CRT) with biventricular pacing has emerged as a new approach for treating patients with heart failure and significant ventricular conduction delay and/or dyssynchrony. 1-3 CRT improves left ventricular systolic and diastolic function 4 and clinical status 5 and reduces functional mitral regurgitation (MR). 6 Whether CRT significantly affects exercise-induced changes in MR has never been investigated. This study examined the effects of CRT on MR and assessed the determinants of exercise-induced changes in MR under biventricular pacing.• • • This prospective study included 27 consecutive patients with heart failure who were clinically helped by biventricular pacing. Before CRT implantation, all were in New York Heart Association class III and had left ventricular ejection fractions Յ35%, functional MR, were in sinus rhythm, had QRS duration Ն140 ms, and had interventricular delay (the time interval between aortic and pulmonary valve opening) Ն50 ms. All patients underwent quantitative exercise Doppler echocardiography with and without active CRT. The causes of heart failure were idiopathic dilated cardiomyopathy in 9 patients and ischemic heart disease in 18. The protocol was approved by the human ethical committee of our university hospital, and all patients gave informed consent.A symptom-limited graded bicycle exercise test was performed in a semisupine position on a tilting exercise table. After an initial workload of 25 W maintained for 2 minutes, the workload was increased every 2 minutes by 25 W. Blood pressure and 12-lead electrocardiograms were recorded every 2 minutes. Two-dimensional and Doppler echocardiographic recordings were available throughout the test.Baseline and exercise echocardiographic studies were performed 45 Ϯ 16 days after implantation of the CRT system using the phased-array Acuson Sequoia (Siemens AG, Munich, Germany) or VIVID 7 (GE Healthcare, Little Chalfont, United Kingdom) imaging device. In 17 patients, after data acquisition during active CRT (CRT on), pacing was interrupted during 30 minutes before data acquisition during intrinsic conduction (CRT off). In the other 10 patients, data were first acquired with CRT off. All echocardiographic and Doppler recordings were obtained in digital format and stored on optical discs for off-line analysis. For each measurement, Ն3 cardiac cycles were averaged. The quantitation of MR was performed by the quantitative Doppler method using mitral and aortic stroke volumes and the proximal isovelocity surface area method, as previously described. 7,8 The results of these 2 methods were averaged, allowing the calculation of regurgitant volume and the effective regurgitant orifice (ERO). Left ventricular end-diastolic and end-systolic volumes and ejection fractions were measured by the bi-apical Simpson disk method. The left ventricular dP/dt was estimated from the steepest increasing segment of the continuous-

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confidence: 99%

“…The reproducibility of echocardiographic measurements has been previously published. 7,11 No patient included was pacing dependent. At the time of echocardiography, all patients were in sinus rhythm and had, by definition, an improvement of Ն1 New York Heart Association class.…”

mentioning

confidence: 99%

Effect of cardiac resynchronization therapy on functional mitral regurgitation in heart failure

Lancellotti¹,

Mélon²,

Sakalihasan

et al. 2004

The American Journal of Cardiology

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102

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“…[5][6][7][8] More than 30% of patients with secondary MR have a clinically sig nificant dynamic increase in MR during exercise; EROA at rest, therefore, does not predict EROA during exercise ( Figure 1). 26,27 Patients who have an exercise induced increase in the severity of secondary MR experience reduced stroke volume adaptation during testing, and often develop pulmonary hypertension and dynamic LV dyssynchrony; all these changes contribute to the limita tion in exercise capacity.…”

Section: Exercise-induced Changes In Mrmentioning

confidence: 99%

“…28 In patients with previous infe rior myocardial infarcts, a lack of contractile reserve can lead to increased annular size and leaflet tethering of the mitral valve during exercise, thereby expanding mitral valve tenting area and increasing the EROA. 5 Similarly, in patients with anterior myocardial infarcts, apical displacement of the mitral leaflet can lead to increased leaflet tenting. In both infarct territories, systolic bulging of the mitral leaflets is the major determinant of dynamic MR. An exercise induced increase in the severity of MR, as indicated by an EROA ≥13 mm 2 , confers a high risk of morbidity (such as acute pulmonary oedema and w orsening heart failure) and mortality.…”

Section: Exercise-induced Changes In Mrmentioning

confidence: 99%

“…1,2 MR is dynamic, with physio logical fluctuations occurring in response to haemo dynamic changes in the cardiocirculatory system, which can precipitate the development of symptoms and subse quent cardiac events. [4][5][6] The dynamic nature of MR has been investigated in patients with various acute cardiac conditions, particularly those with chronic degenera tive or secondary MR. 7,8 Stress echocardiography has an important role in the evaluation of fluctuating MR by providing new prognostic insights and risk stratifica tion parameters, which can help to define the optimal timing of intervention. [9][10][11][12] In this Review, we discuss the characteristics of dynamic MR and the potential mecha nisms underlying its development, as well as the optimal s trategies to treat the condition.…”

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Therapeutic decision-making for patients with fluctuating mitral regurgitation

2015

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| 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).

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2004

Handbook of Echo‐Doppler Interpretation

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Quantitation of functional mitral regurgitation during bicycle exercise in patients with heart failure

Cited by 132 publications

References 34 publications

Effect of cardiac resynchronization therapy on functional mitral regurgitation in heart failure

Effect of cardiac resynchronization therapy on functional mitral regurgitation in heart failure

Therapeutic decision-making for patients with fluctuating mitral regurgitation

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