Document Detail


Exercise does not enhance the prognostic value of Doppler echocardiography in patients with left ventricular systolic dysfunction and functional mitral regurgitation at rest.
MedLine Citation:
PMID:  18371488     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Functional mitral regurgitation (MR) is a powerful predictor of poor prognosis in patients with chronic heart failure (CHF) due to left ventricular systolic dysfunction (LVSD). However, severity of MR varies with dynamic exercise. Accordingly, we sought to assess the prognostic value of exercise-induced changes in functional MR in patients with LVSD and functional MR at rest. METHODS: One hundred four patients with chronic heart failure due to LVSD (ejection fraction [EF] < 45%) and functional MR at rest underwent conventional continuous 2-dimensional Doppler echocardiography at rest and during maximal symptom-limited exercise. The primary end point of the study was all-cause mortality. The median follow-up period was 20 months. RESULTS: Fifty-six patients (54%) had ischemic cardiomyopathy. When feasible, all 56 patients with ischemic cardiomyopathy had undergone revascularization procedures before enrollment into the study. In the whole patient cohort, resting LV end-diastolic volume was 205 +/- 76 mL and EF was 26% +/- 9%. Univariate predictors of death were functional class (New York Heart Association), LV EF, LV end-diastolic volume, resting mitral effective regurgitant orifice, mitral E deceleration time, tricuspid annular plane systolic excursion < or = 14 mm, systolic blood pressure, LV EF, and trans-tricuspid pressure gradient response to exercise. Exercise-induced change in mitral effective regurgitant orifice did not predict survival (HR 0.99, 95% CI 0.94-1.04, P = .63). By Cox multivariate analysis, resting LV end-diastolic volume and tricuspid annular plane systolic excursion < or = 14 mm were the independent predictors of death. CONCLUSIONS: Exercise Doppler echocardiography does not refine the predictive value of resting Doppler echocardiography in patients with LVSD and functional MR at rest.
Authors:
Pierre V Ennezat; Sylvestre Maréchaux; Clémence Huerre; Ghislaine Deklunder; Philippe Asseman; Brigitte Jude; Eric Van Belle; Frédéric Mouquet; Christophe Bauters; Nicolas Lamblin; Thierry H Lejemtel; Pascal de Groote
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Publication Detail:
Type:  Clinical Trial; Journal Article     Date:  2008-02-21
Journal Detail:
Title:  American heart journal     Volume:  155     ISSN:  1097-6744     ISO Abbreviation:  Am. Heart J.     Publication Date:  2008 Apr 
Date Detail:
Created Date:  2008-03-28     Completed Date:  2008-04-18     Revised Date:  2008-09-25    
Medline Journal Info:
Nlm Unique ID:  0370465     Medline TA:  Am Heart J     Country:  United States    
Other Details:
Languages:  eng     Pagination:  752-7     Citation Subset:  AIM; IM    
Affiliation:
Centre Hospitalier Régional et Universitaire de Lille, Cardiovascular Department, Lille, France. ennezat@yahoo.com
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MeSH Terms
Descriptor/Qualifier:
Analysis of Variance
Echocardiography, Doppler*
Echocardiography, Stress
Exercise
Female
Follow-Up Studies
Heart Failure / complications,  physiopathology,  ultrasonography*
Hemodynamics
Humans
Male
Middle Aged
Mitral Valve Insufficiency / etiology*,  ultrasonography
Mortality
Prognosis
Survival Analysis
Ventricular Dysfunction, Left*
Comments/Corrections
Comment In:
Am Heart J. 2008 Sep;156(3):e27; author reply e29-30   [PMID:  18760113 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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