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

Research output: Contribution to journalArticle

4 Citations (Scopus)

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

Fingerprint

Mitral Valve Insufficiency
Exercise Test
Echocardiography
Heart Failure
Exercise
Pulmonary Hypertension
Ventricular Remodeling
Hospitalization
Phenotype
Workload
Heart Ventricles
Dilatation
Blood Pressure
Lung
Mortality

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

Cite this

@article{28413d3ead9d48f797d8a8b9f39b71fe,
title = "Mitral regurgitation in heart failure: Insights from CPET combined with exercise echocardiography",
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. {\circledC} 2016 Published on behalf of the European Society of Cardiology.",
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",
author = "F. Bandera and G. Generati and M. Pellegrino and A. Garatti and V. Labate and E. Alfonzetti and M. Gaeta and S. Castelvecchio and L. Menicanti and M. Guazzi",
note = "Cited By :2 Export Date: 2 March 2018 Correspondence Address: Bandera, F.; University Cardiology Department, IRCCS Policlinico San Donato, University of MilanoItaly; email: francescobandera@gmail.com Tradenames: Philips IE33, Philips Manufacturers: Philips References: Konstam, M.A., Kramer, D.G., Patel, A.R., Maron, M.S., Udelson, J.E., Left ventricular remodeling in heart failure: Current concepts in clinical significance and assessment (2011) JACC Cardiovasc Imaging, 4, pp. 98-108; Pocock, S.J., Wang, D., Pfeffer, M.A., Yusuf, S., McMurray, J.J.V., Swedberg, K.B., Predictors of mortality and morbidity in patients with chronic heart failure (2006) Eur Heart J, 27, pp. 65-75; Trichon, B.H., Felker, G.M., Shaw, L.K., Cabell, C.H., O'Connor, C.M., Relation of frequency and severity of mitral regurgitation to survival among patients with left ventricular systolic dysfunction and heart failure (2003) Am J Cardiol, 91, pp. 538-543; Izumo, M., Suzuki, K., Moonen, M., Kou, S., Shimozato, T., Hayashi, A., Changes in mitral regurgitation and left ventricular geometry during exercise affect exercise capacity in patients with systolic heart failure (2011) Eur J Echocardiogr, 12, pp. 54-60; Grigioni, F., Enriquez-Sarano, M., Zehr, K.J., Bailey, K.R., Tajik, A.J., Ischemic mitral regurgitation: Long-Term outcome and prognostic implications with quantitative Doppler assessment (2001) Circulation, 103, pp. 1759-1764; Cioffi, G., Tarantini, L., De Feo, S., Pulignano, G., Del Sindaco, D., Stefenelli, C., Functional mitral regurgitation predicts 1-year mortality in elderly patients with systolic chronic heart failure (2005) Eur J Heart Fail, 7, pp. 1112-1117; Lancellotti, P., Troisfontaines, P., Toussaint, A.-C., Pierard, L., Prognostic importance of exercise-induced changes in mitral regurgitation in patients with chronic ischemic left ventricular dysfunction (2003) Circulation, 108, pp. 1713-1717; Lancellotti, P., G{\'e}rard, P.L., Pi{\'e}rard, L.A., Long-Term outcome of patients with heart failure and dynamic functional mitral regurgitation (2005) Eur Heart J, 26, pp. 1528-1532; Lapu-Bula, R., Robert, A., Van Craeynest, D., D'Hondt, A.M., Gerber, M.L., Pasquet, A., Contribution of exercise-induced mitral regurgitation to exercise stroke volume and exercise capacity in patients with left ventricular systolic dysfunction (2002) Circulation, 106, pp. 1342-1348; Tumminello, G., Lancellotti, P., Lempereur, M., D'Orio, V., Pierard, L.A., Determinants of pulmonary artery hypertension at rest and during exercise in patients with heart failure (2007) Eur Heart J, 28, pp. 569-574; Bandera, F., Generati, G., Pellegrino, M., Donghi, V., Alfonzetti, E., Gaeta, M., Role of right ventricle and dynamic pulmonary hypertension on determining DVO2/Dwork rate flattening: Insights from cardiopulmonary exercise test combined with exercise echocardiography (2014) Circ Heart Fail, 5, pp. 782-790; Guazzi, M., Arena, R., Ascione, A., Piepoli, M., Guazzi, M.D., Exercise oscillatory breathing and increased ventilation to carbon dioxide production slope in heart failure: An unfavorable combination with high prognostic value (2007) Am Heart J, 153, pp. 859-867; Arena, R., Myers, J., Abella, J., Peberdy, M.A., Bensimhon, D., Chase, P., Development of a ventilatory classification system in patients with heart failure (2007) Circulation, 115, pp. 2410-2417; Lancellotti, P., Tribouilloy, C., Hagendorff, A., Popescu, B.A., Edvardsen, T., Pierard, L.A., Recommendations for the echocardiographic assessment of native valvular regurgitation: An executive summary from the European Association of Cardiovascular Imaging (2013) Eur Heart J Cardiovasc Imaging, 14, pp. 611-644; Tolle, J.J., Waxman, A.B., Van Horn, T.L., Pappagianopoulos, P.P., Systrom, D.M., Exercise-induced pulmonary arterial hypertension (2008) Circulation, 118, pp. 2183-2189; Guazzi, M., Abnormalities in cardiopulmonary exercise testing ventilatory parameters in heart failure: Pathophysiology and clinical usefulness (2014) Curr Heart Fail Rep, 11, pp. 80-87; Corra, U., Giordano, A., Bosimini, E., Mezzani, A., Piepoli, M., Coats, A.J.S., Oscillatory ventilation during exercise in patients with chronic heart failure: Clinical correlates and prognostic implications (2002) Chest, 121, pp. 1572-1580; Magne, J., Lancellotti, P., Pi{\'e}rard, L.A., Exercise-induced changes in degenerative mitral regurgitation (2010) J Am Coll Cardiol, 56, pp. 300-309; Lancellotti, P., Magne, J., Donal, E., O'Connor, K., Dulgheru, R., Rosca, M., Determinants and prognostic significance of exercise pulmonary hypertension in asymptomatic severe aortic stenosis (2012) Circulation, 126, pp. 851-859; Magne, J., Lancellotti, P., Pi{\'e}rard, L.A., Exercise pulmonary hypertension in asymptomatic degenerative mitral regurgitation (2010) Circulation, 122, pp. 33-41; Kusunose, K., Popović, Z.B., Motoki, H., Marwick, T.H., Prognostic significance of exercise-induced right ventricular dysfunction in asymptomatic degenerative mitral regurgitation (2013) Circ Cardiovasc Imaging, 6, pp. 167-176; Ducas, R.A., White, C.W., Wassef, A.W., Farag, A., Bhagirath, K.M., Freed, D.H., Functional mitral regurgitation: Current understanding and approach to management (2014) Can J Cardiol, 30, pp. 173-180",
year = "2017",
doi = "10.1093/ehjci/jew096",
language = "English",
volume = "18",
pages = "296--303",
journal = "European Heart Journal Cardiovascular Imaging",
issn = "2047-2404",
publisher = "Oxford University Press",
number = "3",

}

TY - JOUR

T1 - Mitral regurgitation in heart failure: Insights from CPET combined with exercise echocardiography

AU - Bandera, F.

AU - Generati, G.

AU - Pellegrino, M.

AU - Garatti, A.

AU - Labate, V.

AU - Alfonzetti, E.

AU - Gaeta, M.

AU - Castelvecchio, S.

AU - Menicanti, L.

AU - Guazzi, M.

N1 - Cited By :2 Export Date: 2 March 2018 Correspondence Address: Bandera, F.; University Cardiology Department, IRCCS Policlinico San Donato, University of MilanoItaly; email: francescobandera@gmail.com Tradenames: Philips IE33, Philips Manufacturers: Philips References: Konstam, M.A., Kramer, D.G., Patel, A.R., Maron, M.S., Udelson, J.E., Left ventricular remodeling in heart failure: Current concepts in clinical significance and assessment (2011) JACC Cardiovasc Imaging, 4, pp. 98-108; Pocock, S.J., Wang, D., Pfeffer, M.A., Yusuf, S., McMurray, J.J.V., Swedberg, K.B., Predictors of mortality and morbidity in patients with chronic heart failure (2006) Eur Heart J, 27, pp. 65-75; Trichon, B.H., Felker, G.M., Shaw, L.K., Cabell, C.H., O'Connor, C.M., Relation of frequency and severity of mitral regurgitation to survival among patients with left ventricular systolic dysfunction and heart failure (2003) Am J Cardiol, 91, pp. 538-543; Izumo, M., Suzuki, K., Moonen, M., Kou, S., Shimozato, T., Hayashi, A., Changes in mitral regurgitation and left ventricular geometry during exercise affect exercise capacity in patients with systolic heart failure (2011) Eur J Echocardiogr, 12, pp. 54-60; Grigioni, F., Enriquez-Sarano, M., Zehr, K.J., Bailey, K.R., Tajik, A.J., Ischemic mitral regurgitation: Long-Term outcome and prognostic implications with quantitative Doppler assessment (2001) Circulation, 103, pp. 1759-1764; Cioffi, G., Tarantini, L., De Feo, S., Pulignano, G., Del Sindaco, D., Stefenelli, C., Functional mitral regurgitation predicts 1-year mortality in elderly patients with systolic chronic heart failure (2005) Eur J Heart Fail, 7, pp. 1112-1117; Lancellotti, P., Troisfontaines, P., Toussaint, A.-C., Pierard, L., Prognostic importance of exercise-induced changes in mitral regurgitation in patients with chronic ischemic left ventricular dysfunction (2003) Circulation, 108, pp. 1713-1717; Lancellotti, P., Gérard, P.L., Piérard, L.A., Long-Term outcome of patients with heart failure and dynamic functional mitral regurgitation (2005) Eur Heart J, 26, pp. 1528-1532; Lapu-Bula, R., Robert, A., Van Craeynest, D., D'Hondt, A.M., Gerber, M.L., Pasquet, A., Contribution of exercise-induced mitral regurgitation to exercise stroke volume and exercise capacity in patients with left ventricular systolic dysfunction (2002) Circulation, 106, pp. 1342-1348; Tumminello, G., Lancellotti, P., Lempereur, M., D'Orio, V., Pierard, L.A., Determinants of pulmonary artery hypertension at rest and during exercise in patients with heart failure (2007) Eur Heart J, 28, pp. 569-574; Bandera, F., Generati, G., Pellegrino, M., Donghi, V., Alfonzetti, E., Gaeta, M., Role of right ventricle and dynamic pulmonary hypertension on determining DVO2/Dwork rate flattening: Insights from cardiopulmonary exercise test combined with exercise echocardiography (2014) Circ Heart Fail, 5, pp. 782-790; Guazzi, M., Arena, R., Ascione, A., Piepoli, M., Guazzi, M.D., Exercise oscillatory breathing and increased ventilation to carbon dioxide production slope in heart failure: An unfavorable combination with high prognostic value (2007) Am Heart J, 153, pp. 859-867; Arena, R., Myers, J., Abella, J., Peberdy, M.A., Bensimhon, D., Chase, P., Development of a ventilatory classification system in patients with heart failure (2007) Circulation, 115, pp. 2410-2417; Lancellotti, P., Tribouilloy, C., Hagendorff, A., Popescu, B.A., Edvardsen, T., Pierard, L.A., Recommendations for the echocardiographic assessment of native valvular regurgitation: An executive summary from the European Association of Cardiovascular Imaging (2013) Eur Heart J Cardiovasc Imaging, 14, pp. 611-644; Tolle, J.J., Waxman, A.B., Van Horn, T.L., Pappagianopoulos, P.P., Systrom, D.M., Exercise-induced pulmonary arterial hypertension (2008) Circulation, 118, pp. 2183-2189; Guazzi, M., Abnormalities in cardiopulmonary exercise testing ventilatory parameters in heart failure: Pathophysiology and clinical usefulness (2014) Curr Heart Fail Rep, 11, pp. 80-87; Corra, U., Giordano, A., Bosimini, E., Mezzani, A., Piepoli, M., Coats, A.J.S., Oscillatory ventilation during exercise in patients with chronic heart failure: Clinical correlates and prognostic implications (2002) Chest, 121, pp. 1572-1580; Magne, J., Lancellotti, P., Piérard, L.A., Exercise-induced changes in degenerative mitral regurgitation (2010) J Am Coll Cardiol, 56, pp. 300-309; Lancellotti, P., Magne, J., Donal, E., O'Connor, K., Dulgheru, R., Rosca, M., Determinants and prognostic significance of exercise pulmonary hypertension in asymptomatic severe aortic stenosis (2012) Circulation, 126, pp. 851-859; Magne, J., Lancellotti, P., Piérard, L.A., Exercise pulmonary hypertension in asymptomatic degenerative mitral regurgitation (2010) Circulation, 122, pp. 33-41; Kusunose, K., Popović, Z.B., Motoki, H., Marwick, T.H., Prognostic significance of exercise-induced right ventricular dysfunction in asymptomatic degenerative mitral regurgitation (2013) Circ Cardiovasc Imaging, 6, pp. 167-176; Ducas, R.A., White, C.W., Wassef, A.W., Farag, A., Bhagirath, K.M., Freed, D.H., Functional mitral regurgitation: Current understanding and approach to management (2014) Can J Cardiol, 30, pp. 173-180

PY - 2017

Y1 - 2017

N2 - 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.

AB - 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.

KW - exercise echocardiography

KW - functional mitral regurgitation

KW - heart failure

KW - pulmonary hypertension

KW - right ventricle

KW - adult

KW - aged

KW - Article

KW - cardiopulmonary exercise test

KW - cardiovascular mortality

KW - controlled study

KW - disease severity

KW - female

KW - follow up

KW - functional disease

KW - heart dilatation

KW - heart failure with reduced ejection fraction

KW - heart left ventricle enddiastolic volume

KW - heart right ventricle failure

KW - heart ventricle remodeling

KW - heart work

KW - hospitalization

KW - human

KW - lung pressure

KW - major clinical study

KW - male

KW - middle aged

KW - mitral valve regurgitation

KW - phenotype

KW - priority journal

KW - real time ultrasound scanner

KW - rest

KW - stress echocardiography

KW - systolic blood pressure

KW - analysis of variance

KW - cohort analysis

KW - comorbidity

KW - comparative study

KW - diagnostic imaging

KW - exercise test

KW - heart left ventricle function

KW - heart stroke volume

KW - heart valve replacement

KW - mortality

KW - nonparametric test

KW - pathophysiology

KW - physiology

KW - procedures

KW - retrospective study

KW - severity of illness index

KW - survival analysis

KW - time factor

KW - Aged

KW - Analysis of Variance

KW - Cohort Studies

KW - Comorbidity

KW - Echocardiography, Stress

KW - Exercise Test

KW - Female

KW - Follow-Up Studies

KW - Heart Failure

KW - Heart Valve Prosthesis Implantation

KW - Humans

KW - Male

KW - Middle Aged

KW - Mitral Valve Insufficiency

KW - Retrospective Studies

KW - Severity of Illness Index

KW - Statistics, Nonparametric

KW - Stroke Volume

KW - Survival Analysis

KW - Time Factors

KW - Ventricular Dysfunction, Left

U2 - 10.1093/ehjci/jew096

DO - 10.1093/ehjci/jew096

M3 - Article

VL - 18

SP - 296

EP - 303

JO - European Heart Journal Cardiovascular Imaging

JF - European Heart Journal Cardiovascular Imaging

SN - 2047-2404

IS - 3

ER -