Mitral regurgitation in heart failure: Insights from CPET combined with exercise echocardiography

Research output: Contribution to journalArticle

Abstract

Aims In heart failure patients with reduced ejection fraction (HFrEF), exercise-induced functional mitral regurgitation (MR) may affect functional capacity and outcome. We sought to study functional and cardiac phenotypes of HFrEF patients according to the MR degree. Methods and results We performed rest and exercise echocardiography (Ex-Echo), simultaneously combined with cardiopulmonary exercise test (CPET), in 102 HFrEF patients, identifying 3 groups: non-severe (ERO <20 mm2) MR (group A), exercise-induced severe (ERO ≥20 mm2) MR (group B), and rest severe MR (group C). Patients were tracked for the composite end point of death and heart failure hospitalization. Group B (ERO: Rest= 14 ± 5 mm2, Ex= 28 ± 6 mm2; P = < 0.001) had a functional impairment (workload = 56 ± 21 vs. 50 ± 17 watts, P = 0.42; peak VO2 = 11.8 ± 3.2 vs. 11.5 ± 3.0 mL/Kg/min, P = 0.70) similar to Group C (ERO: Rest = 29 ± 7 mm2, Ex = 42 ± 7 mm2, P = < 0.001), associated with comparable advanced left ventricle remodelling (end diastolic indexed volume = 107 ± 34 vs. 115 ± 30 mL/m2, P = 0.27), characterized by exercise-induced pulmonary hypertension (PH) (Ex systolic pulmonary pressures = 63 ± 16 mmHg). Group C showed the worse cardiac phenotype (right ventricle dilatation, dysfunction, and rest PH) with severe ventilatory impairment (VE/VCO2 = 41.2 ± 11) compared with Groups A and B. Moreover, Group C had the higher rate of death and HF hospitalization. Conclusions In HFrEF patients, severe dynamic MR produces functional limitation similar to rest severe MR, characterized by dynamic PH. Rest severe MR reflects the most advanced bi-ventricular remodelling associated with rest PH, the most unfavourable ventilatory profile, and the worst mid-term outcome. © 2016 Published on behalf of the European Society of Cardiology.
Original languageEnglish
Pages (from-to)296-303
Number of pages8
JournalEuropean Heart Journal Cardiovascular Imaging
Volume18
Issue number3
DOIs
Publication statusPublished - 2017

Keywords

  • exercise echocardiography
  • functional mitral regurgitation
  • heart failure
  • pulmonary hypertension
  • right ventricle
  • adult
  • aged
  • Article
  • cardiopulmonary exercise test
  • cardiovascular mortality
  • controlled study
  • disease severity
  • female
  • follow up
  • functional disease
  • heart dilatation
  • heart failure with reduced ejection fraction
  • heart left ventricle enddiastolic volume
  • heart right ventricle failure
  • heart ventricle remodeling
  • heart work
  • hospitalization
  • human
  • lung pressure
  • major clinical study
  • male
  • middle aged
  • mitral valve regurgitation
  • phenotype
  • priority journal
  • real time ultrasound scanner
  • rest
  • stress echocardiography
  • systolic blood pressure
  • analysis of variance
  • cohort analysis
  • comorbidity
  • comparative study
  • diagnostic imaging
  • exercise test
  • heart left ventricle function
  • heart stroke volume
  • heart valve replacement
  • mortality
  • nonparametric test
  • pathophysiology
  • physiology
  • procedures
  • retrospective study
  • severity of illness index
  • survival analysis
  • time factor
  • Aged
  • Analysis of Variance
  • Cohort Studies
  • Comorbidity
  • Echocardiography, Stress
  • Exercise Test
  • Female
  • Follow-Up Studies
  • Heart Failure
  • Heart Valve Prosthesis Implantation
  • Humans
  • Male
  • Middle Aged
  • Mitral Valve Insufficiency
  • Retrospective Studies
  • Severity of Illness Index
  • Statistics, Nonparametric
  • Stroke Volume
  • Survival Analysis
  • Time Factors
  • Ventricular Dysfunction, Left

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