| Exercise pulmonary hypertension in asymptomatic degenerative mitral regurgitation. | |
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MedLine Citation:
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PMID: 20566950 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Current guidelines recommend mitral valve surgery for asymptomatic patients with severe degenerative mitral regurgitation and preserved left ventricular systolic function when exercise pulmonary hypertension (PHT) is present. However, the determinants of exercise PHT have not been evaluated. The aim of this study was to identify the echocardiographic predictors of exercise PHT and the impact on symptoms. METHODS AND RESULTS: Comprehensive resting and exercise transthoracic echocardiography was performed in 78 consecutive patients (age, 61+/-13 years; 56% men) with at least moderate degenerative mitral regurgitation (effective regurgitant orifice area =43+/-20 mm(2); regurgitant volume =71+/-27 mL). Exercise PHT was defined as a systolic pulmonary arterial pressure (SPAP) >60 mm Hg. Exercise PHT was present in 46% patients. In multivariable analysis, exercise effective regurgitant orifice was an independent determinant of exercise SPAP (P<0.0001) and exercise PHT (P=0.002). Resting PHT and exercise PHT were associated with markedly reduced 2-year symptom-free survival (36+/-14% versus 59+/-7%, P=0.04; 35+/-8% versus 75+/-7%, P<0.0001). After adjustment, although the impact of resting PHT was no longer significant, exercise PHT was identified as an independent predictor of the occurrence of symptoms (hazard ratio=3.4; P=0.002). Receiver-operating characteristics curves revealed that exercise PHT (SPAP >56 mm Hg) was more accurate than resting PHT (SPAP >36 mm Hg) in predicting the occurrence of symptoms during follow-up (P=0.032). CONCLUSIONS: Exercise PHT is frequent in patients with asymptomatic degenerative mitral regurgitation. Exercise mitral regurgitation severity is a strong independent predictor of both exercise SPAP and exercise PHT. Exercise PHT is associated with markedly low 2-year symptom-free survival, emphasizing the use of exercise echocardiography. An exercise SPAP >56 mm Hg accurately predicts the occurrence of symptoms. |
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Authors:
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Julien Magne; Patrizio Lancellotti; Luc A Piérard |
Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't Date: 2010-06-21 |
Journal Detail:
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Title: Circulation Volume: 122 ISSN: 1524-4539 ISO Abbreviation: Circulation Publication Date: 2010 Jul |
Date Detail:
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Created Date: 2010-07-07 Completed Date: 2010-08-10 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0147763 Medline TA: Circulation Country: United States |
Other Details:
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Languages: eng Pagination: 33-41 Citation Subset: AIM; IM |
Affiliation:
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Department of Cardiology, Heart Valve Disease Clinic, University Hospital Sart Tilman, University of Liège, Belgium. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Blood Pressure Diabetes Complications / physiopathology Diastole / physiology Disease-Free Survival Echocardiography Exercise Humans Hypercholesterolemia / complications Hypertension / complications Hypertension, Pulmonary / epidemiology*, etiology, mortality, physiopathology Middle Aged Mitral Valve Insufficiency / complications*, mortality, physiopathology Multivariate Analysis Physical Exertion Regression Analysis Risk Factors Smoking / epidemiology Survivors Systole / physiology |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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