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Prognostic Significance of Exercise Induced Right Ventricular Dysfunction in Asymptomatic Degenerative Mitral Regurgitation.
MedLine Citation:
PMID:  23357242     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND: -The role of exercise-induced pulmonary hypertension (exPHT) in decision-making regarding surgical timing for asymptomatic chronic mitral regurgitation (MR) is controversial. We reasoned that the exPHT response could not be interpreted without knowledge of right ventricular (RV) function. The aim of this study was to assess the role of RV measures at rest and during exercise as predictors of prognosis in asymptomatic MR. METHODS AND RESULTS: -Comprehensive resting and exercise echocardiography was performed in 196 consecutive patients (56±13y; 64% male) with isolated moderate to severe MR (effective regurgitant orifice area 38±18 mm(2)) and preserved left ventricular (LV) function in whom initial management was expectant. LV and RV longitudinal strain were analyzed at rest using velocity vector imaging. Tricuspid annular plane systolic excursion (TAPSE) and systolic pulmonary arterial pressure (SPAP) were measured at rest and during exercise. Valve surgery was performed in 88 patients (45%) over 27±15 months. After adjustment for age and gender in a Cox proportional-hazards model, exercise TAPSE (HR=0.26, p<0.001), was associated with valve surgery-free survival, independent of resting LV strain (HR=1.09, p=0.027), exercise SPAP (HR=1.03, p<0.001) and resting RV strain (HR=1.10, p=0.004). In sequential Cox models, a model based on clinical data and LV strain (chi-square, 15.9) was improved by RV strain and RV chamber size (chi-square, 28.8, p=0.003) and exercise SPAP (chi-square, 40.1, p=0.002) and further increased by exercise TAPSE (chi-square, 52.2, p=0.002). CONCLUSIONS: -Exercise-induced RV dysfunction provides important incremental prognostic value in the management of asymptomatic MR.
Authors:
Kenya Kusunose; Zoran B Popovic; Hirohiko Motoki; Thomas H Marwick
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-1-28
Journal Detail:
Title:  Circulation. Cardiovascular imaging     Volume:  -     ISSN:  1942-0080     ISO Abbreviation:  Circ Cardiovasc Imaging     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2013-1-29     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101479935     Medline TA:  Circ Cardiovasc Imaging     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
1Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH.
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