Exercise does not enhance the prognostic value of Doppler echocardiography in patients with left ventricular systolic dysfunction and functional mitral regurgitation at rest

• Published in: The American heart journal Vol. 155; no. 4; pp. 752 - 757
• Main Authors: Ennezat, Pierre V., MD, Maréchaux, Sylvestre, MD, Huerre, Clémence, MD, Deklunder, Ghislaine, MD, Asseman, Philippe, MD, Jude, Brigitte, MD, Van Belle, Eric, MD, Mouquet, Frédéric, MD, Bauters, Christophe, MD, Lamblin, Nicolas, MD, LeJemtel, Thierry H., MD, de Groote, Pascal, MD
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.04.2008; Elsevier; Elsevier Limited
• Subjects: Analysis of Variance; Biological and medical sciences; Cardiology; Cardiology. Vascular system; Cardiovascular; Cardiovascular disease; Cardiovascular system; Coronary vessels; Diabetes; Drug therapy; Echocardiography, Doppler; Echocardiography, Stress; Endocardial and cardiac valvular diseases; Enzymes; Exercise; Female; Follow-Up Studies; Heart; Heart attacks; Heart failure; Heart Failure - complications; Heart Failure - diagnostic imaging; Heart Failure - physiopathology; Heart failure, cardiogenic pulmonary edema, cardiac enlargement; Heart rate; Hemodynamics; Humans; Hypertension; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Middle Aged; Mitral Valve Insufficiency - diagnostic imaging; Mitral Valve Insufficiency - etiology; Mortality; Multivariate analysis; Population; Prognosis; Pulmonary arteries; Survival Analysis; Ultrasonic investigative techniques; Variables; Ventricular Dysfunction, Left; Sonography; Physical exercise; Human; Mitral valve; Prognosis; Cardiovascular disease; Heart ventricle; Left ventricular failure; Duplex ultrasonography; Rest; Cardiac valvular disease; Mitral regurgitation; Medical imagery; Exercise tolerance test; Circulatory system; Cardiology; Left ventricle performance
• ISSN: 0002-8703; 1097-6744
• DOI: 10.1016/j.ahj.2007.11.022

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 ≤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 ≤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.