Determinants of exercise-induced changes in mitral regurgitation in patients with coronary artery disease and left ventricular dysfunction.
OBJECTIVE
We sought to examine the determinants of exercise-induced changes in ischemic mitral regurgitation (MR) in patients with left ventricular (LV) dysfunction.


BACKGROUND
In the post-myocardial infarction (MI) phase, ischemic MR contributes to worsening of symptoms and of LV dysfunction.


METHODS
In this study, 70 patients in the chronic, post-MI phase, with LV ejection fraction <45% and at least mild MR, underwent semi-supine exercise Doppler echocardiography. The effective regurgitant orifice (ERO) of MR was quantified at rest and during exercise. Exercise-induced changes in ERO were compared with changes in mitral deformation and in local and global LV remodeling.


RESULTS
The wide range of exercise-induced ERO changes that were observed was unrelated to the degree of MR at rest (r = 0.20). Effective regurgitant orifice changes correlated best with changes in mitral deformation (i.e., differences in systolic mitral tenting area, systolic annular area, and coaptation height) (p < 0.0001). Posterior displacement of the papillary muscles was associated with larger changes in the ERO in both infarct groups. In patients with inferior MI, a decrease in the ERO was related to improvement in wall motion (r = 0.68). The independent predictors of ERO changes during exercise were changes in systolic annular area for all infarct categories, in tenting area and wall motion score in the global population and those with inferior infarction, and in apical displacement of mitral leaflets for patients with anterior MI.


CONCLUSIONS
The degree of MR at rest is unrelated to exercise-induced changes in EROs, which are related to those in local LV remodeling and in mitral deformation but not those in global LV function.
Lancellotti
Patrizio
P
Department of Cardiology, University Hospital of Liège, Liège, Belgium.
Lebrun
Frédéric
F
Piérard
Luc A
LA
D015150:Echocardiography, Doppler; D015444:Exercise / Q000502:physiology*; D006801:Humans; D008943:Mitral Valve / Q000503:physiopathology; D008944:Mitral Valve Insufficiency / Q000503:physiopathology*; D009203:Myocardial Infarction / Q000150:complications*; D015203:Reproducibility of Results; D018487:Ventricular Dysfunction, Left / Q000150:complications*; D020257:Ventricular Remodeling / Q000502:physiology