Document Detail


Prognostic value of exercise tolerance testing in asymptomatic chronic nonischemic mitral regurgitation.
MedLine Citation:
PMID:  17920370     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
In many heart diseases, exercise tolerance testing (ETT) has useful functional correlates and/or prognostic value. However, its predictive value in mitral regurgitation (MR) is undefined. To determine whether ETT descriptors predict death or indications for mitral valve surgery in patients with MR, we prospectively followed, for 7 +/- 3 end-point-free years, a cohort of 38 patients with chronic severe nonischemic MR who underwent modified Bruce ETT; all lacked surgical indications at study entry. Their baseline exercise descriptors were also compared with those from 46 patients with severe MR who, at entry, already had reached surgical indications. End points during follow-up in the cohort included sudden death (n = 1), heart failure symptoms (n = 2), atrial fibrillation (n = 4), left ventricular (LV) ejection fraction <60% (n = 2), LV systolic dimensions > or =45 mm (n = 12) and >40 mm (n = 11), LV ejection fraction <60% plus LV systolic dimensions > or =45 mm (n = 3), and heart failure plus LV systolic dimensions > or =45 mm plus LV ejection fraction <60% (n = 1). In univariate analysis, exercise duration (p = 0.004), chronotropic response (p = 0.007), percent predicted peak heart rate (p = 0.01), and heart rate recovery (p <0.02) predicted events; in multivariate analysis, only exercise duration was predictive (p <0.02). Average annual event risk was fivefold lower (4.62%) with an exercise duration > or =15 versus <15 minutes (average annual risk 23.48%, p = 0.004). Relative risks in patients with and without exercise-inducible ST-segment depression were comparable (< or =1.3, p = NS) whether defined at entry and/or during follow-up. Exercise duration, but not prevalence of exercise-inducible ST-segment depression, was lower (p <0.001) in patients with surgical indications at entry versus initially end-point-free patients. In conclusion, in asymptomatic patients with chronic severe nonischemic MR and no objective criteria for operation, progression to surgical indications generally is rapid. However, those with excellent exercise tolerance have a relatively benign course. Exercise-inducible ST-segment depression has no prognostic value in this population.
Authors:
Phyllis G Supino; Jeffrey S Borer; Karlheinz Schuleri; Anuj Gupta; Clare Hochreiter; Paul Kligfield; Edmund McM Herrold; Jacek J Preibisz
Publication Detail:
Type:  Evaluation Studies; Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't     Date:  2007-07-23
Journal Detail:
Title:  The American journal of cardiology     Volume:  100     ISSN:  0002-9149     ISO Abbreviation:  Am. J. Cardiol.     Publication Date:  2007 Oct 
Date Detail:
Created Date:  2007-10-08     Completed Date:  2007-11-27     Revised Date:  2013-09-03    
Medline Journal Info:
Nlm Unique ID:  0207277     Medline TA:  Am J Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1274-81     Citation Subset:  AIM; IM    
Affiliation:
Department of Medicine, Weill Cornell Medical College, New York, NY, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Cohort Studies
Echocardiography
Exercise Tolerance*
Female
Humans
Male
Middle Aged
Mitral Valve Insufficiency / diagnosis*,  physiopathology*,  ultrasonography
Predictive Value of Tests
Prospective Studies
Grant Support
ID/Acronym/Agency:
R01 HL 26504/HL/NHLBI NIH HHS; R01 HL026504-05/HL/NHLBI NIH HHS
Comments/Corrections
Comment In:
Am J Cardiol. 2008 Apr 1;101(7):1071-2   [PMID:  18359341 ]

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