title: Cardiac resynchronisation therapy reduces functional mitral regurgitation during dynamic exercise in patients with chronic heart failure: an acute echocardiographic study.
abstract: OBJECTIVE
  To assess non-invasively the acute effects of cardiac resynchronisation therapy (CRT) on functional mitral regurgitation (MR) at rest and during dynamic exercise.
  
  
  METHODS
  21 patients with left ventricular (LV) systolic dysfunction and functional MR at rest, treated with CRT, were studied. Each patient performed a symptom-limited maximal exercise with continuous two dimensional Doppler echocardiography twice. The first exercise was performed with CRT; the second exercise was performed without CRT. Mitral regurgitant flow volume (RV), effective regurgitant orifice area (ERO) and LV dP/dt were measured at rest and at peak exercise.
  
  
  RESULTS
  CRT mildly reduced resting mitral ERO (mean 8 (SEM 2) v 11 (2) mm(2) without CRT, p = 0.02) and RV (13 (3) v 18 (3) ml without CRT, p = 0.03). CRT attenuated the spontaneous increase in mitral ERO and RV during exercise (1 (1) v 9 (2) mm(2), p = 0.004 and 1 (1) v 8 (2) ml, p = 0.004, respectively). CRT also significantly increased exercise-induced changes in LV dP/dt (140 (46) v 479 (112) mm Hg/s, p < 0.001).
  
  
  CONCLUSIONS
  Attenuation of functional MR, induced by an increase in LV contractility during dynamic exercise, may contribute to the beneficial clinical outcome of CRT in patients with chronic heart failure and LV asynchrony.
authors.affiliation: Cardiology Hospital, Lille, France. ennezat@yahoo.com
authors.forename: P-V
authors.initials: PV
authors.lastname: Ennezat
authors.forename: B
authors.initials: B
authors.lastname: Gal
authors.forename: C
authors.initials: C
authors.lastname: Kouakam
authors.forename: C
authors.initials: C
authors.lastname: Marquie
authors.forename: T
authors.initials: T
authors.lastname: LeTourneau
authors.forename: D
authors.initials: D
authors.lastname: Klug
authors.forename: D
authors.initials: D
authors.lastname: Lacroix
authors.forename: D
authors.initials: D
authors.lastname: Logeart
authors.forename: A
authors.initials: A
authors.lastname: Cohen-Solal
authors.forename: S
authors.initials: S
authors.lastname: Dennetière
authors.forename: E
authors.initials: E
authors.lastname: Van Belle
authors.forename: G
authors.initials: G
authors.lastname: Deklunder
authors.forename: P
authors.initials: P
authors.lastname: Asseman
authors.forename: P
authors.initials: P
authors.lastname: de Groote
authors.forename: S
authors.initials: S
authors.lastname: Kacet
authors.forename: T H
authors.initials: TH
authors.lastname: LeJemtel
mesh_terms: D000368:Aged; D001794:Blood Pressure / Q000502:physiology; D002304:Cardiac Pacing, Artificial; D002311:Cardiomyopathy, Dilated / Q000503:physiopathology / Q000628:therapy*; D015150:Echocardiography, Doppler; D018618:Echocardiography, Doppler, Color; D005080:Exercise Test; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D008297:Male; D008944:Mitral Valve Insufficiency / Q000503:physiopathology / Q000517:prevention & control*; D013318:Stroke Volume / Q000502:physiology; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology