Exercise does not enhance the prognostic value of Doppler echocardiography in patients with left ventricular systolic dysfunction and functional mitral regurgitation at rest.
BACKGROUND
Functional mitral regurgitation (MR) is a powerful predictor of poor prognosis in patients with chronic heart failure (CHF) due to left ventricular systolic dysfunction (LVSD). However, severity of MR varies with dynamic exercise. Accordingly, we sought to assess the prognostic value of exercise-induced changes in functional MR in patients with LVSD and functional MR at rest.


METHODS
One hundred four patients with chronic heart failure due to LVSD (ejection fraction [EF] < 45%) and functional MR at rest underwent conventional continuous 2-dimensional Doppler echocardiography at rest and during maximal symptom-limited exercise. The primary end point of the study was all-cause mortality. The median follow-up period was 20 months.


RESULTS
Fifty-six patients (54%) had ischemic cardiomyopathy. When feasible, all 56 patients with ischemic cardiomyopathy had undergone revascularization procedures before enrollment into the study. In the whole patient cohort, resting LV end-diastolic volume was 205 +/- 76 mL and EF was 26% +/- 9%. Univariate predictors of death were functional class (New York Heart Association), LV EF, LV end-diastolic volume, resting mitral effective regurgitant orifice, mitral E deceleration time, tricuspid annular plane systolic excursion < or = 14 mm, systolic blood pressure, LV EF, and trans-tricuspid pressure gradient response to exercise. Exercise-induced change in mitral effective regurgitant orifice did not predict survival (HR 0.99, 95% CI 0.94-1.04, P = .63). By Cox multivariate analysis, resting LV end-diastolic volume and tricuspid annular plane systolic excursion < or = 14 mm were the independent predictors of death.


CONCLUSIONS
Exercise Doppler echocardiography does not refine the predictive value of resting Doppler echocardiography in patients with LVSD and functional MR at rest.
Ennezat
Pierre V
PV
Centre Hospitalier Régional et Universitaire de Lille, Cardiovascular Department, Lille, France. ennezat@yahoo.com
Maréchaux
Sylvestre
S
Huerre
Clémence
C
Deklunder
Ghislaine
G
Asseman
Philippe
P
Jude
Brigitte
B
Van Belle
Eric
E
Mouquet
Frédéric
F
Bauters
Christophe
C
Lamblin
Nicolas
N
Lejemtel
Thierry H
TH
de Groote
Pascal
P
D000704:Analysis of Variance; D015150:Echocardiography, Doppler; D025401:Echocardiography, Stress; D015444:Exercise; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000209:etiology*; D009026:Mortality; D011379:Prognosis; D016019:Survival Analysis; D018487:Ventricular Dysfunction, Left