Document Detail


Functional and prognostic implications of left ventricular contractile reserve in patients with asymptomatic severe mitral regurgitation.
MedLine Citation:
PMID:  16230438     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To evaluate contractile reserve (CR) determined by exercise echocardiography in predicting clinical outcome and left ventricular (LV) function in asymptomatic severe mitral regurgitation (MR). DESIGN: Cohort study. SETTING: Regional cardiac centre. PATIENTS AND OUTCOME MEASURES: LV volumes and ejection fraction (EF) were measured at rest and after stress in 71 patients with isolated MR. During follow up (mean (SD) 3 (1) years), EF and functional capacity were serially assessed and cardiac events (cardiac death, heart failure, and new atrial fibrillation) were documented. RESULTS: CR was present in 45 patients (CR+) and absent in 26 patients (CR-). Age, resting LV dimensions, EF, and MR severity were similar in both groups. Mitral surgery was performed in 19 of 45 (42%) CR+ patients and 22 of 26 (85%) CR- patients. In patients undergoing surgery, CR was an independent predictor of follow up EF (p = 0.006) and postoperative LV dysfunction (EF < 50%) persisted in five patients, all in the CR- group. Event-free survival was lower in surgically treated patients without CR (p = 0.03). In medically treated patients, follow up EF was preserved in those with intact CR but progressively deteriorated in patients without CR, in whom functional capacity also deteriorated. CONCLUSIONS: Evaluation of CR by exercise echocardiography may be useful for risk stratification and may help to optimise the timing of surgery in asymptomatic severe MR.
Authors:
R Lee; B Haluska; D Y Leung; C Case; J Mundy; T H Marwick
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Heart (British Cardiac Society)     Volume:  91     ISSN:  1468-201X     ISO Abbreviation:  Heart     Publication Date:  2005 Nov 
Date Detail:
Created Date:  2005-10-18     Completed Date:  2005-12-15     Revised Date:  2009-11-18    
Medline Journal Info:
Nlm Unique ID:  9602087     Medline TA:  Heart     Country:  England    
Other Details:
Languages:  eng     Pagination:  1407-12     Citation Subset:  AIM; IM    
Affiliation:
University of Queensland, Brisbane, Australia.
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MeSH Terms
Descriptor/Qualifier:
Chronic Disease
Cohort Studies
Echocardiography / methods
Echocardiography, Stress / methods
Epidemiologic Methods
Female
Humans
Male
Middle Aged
Mitral Valve Insufficiency / physiopathology*,  surgery
Postoperative Period
Prognosis
Stroke Volume / physiology
Ventricular Dysfunction, Left / physiopathology*
Comments/Corrections
Comment In:
Heart. 2005 Nov;91(11):1383-4   [PMID:  16230432 ]

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