title: Tissue Doppler echocardiography reveals insufficient contractile reserve recruitment during effort in subjects with mitral valve prolapse and those with thick mitral valve.
abstract: OBJECTIVE
  To assess by tissue Doppler echocardiography (TDE), the tissue velocities, both at rest and after exercise stress testing, in subjects with mitral valve prolapse (MVP) and those with thick mitral valve (TMV).
  
  
  METHODS
  Twenty individuals with typical MVP, 30 with TMV, and 30 healthy controls were enrolled. TDE was performed at the basal-inferior wall and the parameters evaluated were the S, Em, and Am velocities, as well as the Em/Am ratio.
  
  
  RESULTS
  The mean S-wave at rest was higher in subjects with MVP compared to that of the TMV (P < 0.01) and the control groups (P = 0.00005), whereas after exercise it was higher in the control group compared to either MVP (P = 0.013) or TMV group (P = 0.00002). The mean Em wave at rest was higher in the control individuals both at rest (P = 0.007 compared with MVP group and P = 0.013 compared with TMV group), and after exercise (P = 0.0002 and 0.0009, respectively). The Am wave in the MVP group was higher compared with TMV and control subjects at rest (P = 0.022 and 0.00001, respectively) but it was not after exercise (P = ns for both comparisons). The Em/Am ratio of the control group at rest was higher than that of the MVP (P = 0.0000) and TMV (P = 0.00028) groups. However, after exercise, it was higher only when compared with the MVP group (P = 0.016).
  
  
  CONCLUSIONS
  Subjects with MVP and those with TMV exhibit a less effective contractile response to exercise compared to healthy individuals. Some degree of diastolic dysfunction, particularly after exercise, was also detected in the individuals with MVP.
authors.affiliation: Department of Cardiology, Athens General Hospital, Athens, Greece.
authors.forename: John D
authors.initials: JD
authors.lastname: Zampoulakis
authors.forename: Apostolos I
authors.initials: AI
authors.lastname: Karavidas
authors.forename: Evangellos
authors.initials: E
authors.lastname: Matsakas
authors.forename: George A
authors.initials: GA
authors.lastname: Lazaros
authors.forename: Naoum T
authors.initials: NT
authors.lastname: Karaminas
authors.forename: Ioannis N
authors.initials: IN
authors.lastname: Fotiadis
authors.forename: Fotis K
authors.initials: FK
authors.lastname: Panou
authors.forename: Apostolos
authors.initials: A
authors.lastname: Zacharoulis
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D016022:Case-Control Studies; D015150:Echocardiography, Doppler; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000503:physiopathology; D008945:Mitral Valve Prolapse / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D009200:Myocardial Contraction