title: Changes in mitral regurgitation and left ventricular geometry during exercise affect exercise capacity in patients with systolic heart failure.
abstract: OBJECTIVE
  exercise may dramatically change the extent of functional mitral regurgitation (MR) and left ventricular (LV) geometry in patients with chronic heart failure (CHF). We hypothesized that dynamic changes in MR and LV geometry would affect exercise capacity.
  
  
  RESULTS
  this study included 30 CHF patients with functional MR who underwent symptom-limited bicycle exercise stress echocardiography and cardiopulmonary exercise testing for quantitative assessment of MR (effective regurgitant orifice; ERO), and pulmonary artery systolic pressure (PASP). LV sphericity index was obtained from real-time three-dimensional echocardiograms. The patients were stratified into exercised-induced MR (EMR; n = 10, an increase in ERO by ≥13 mm(2)) or non-EMR (NEMR; n = 20, an increase in ERO by <13 mm(2)) group. At rest, no differences in LV volume and function, ERO, and PASP were found between the two groups. At peak exercise, PASP and sphericity index were significantly greater (all P < 0.01) in the EMR group. The EMR group revealed lower peak oxygen uptake (peak VO(2); P = 0.018) and greater minute ventilation/carbon dioxide production slope (VE/VCO(2) slope; P = 0.042) than the NEMR group. Peak VO(2) negatively correlated with changes in ERO (r = -0.628) and LV sphericity index (r = -0.437); meanwhile, VE/VCO(2) slope was well correlated with these changes (r = 0.414 and 0.364, respectively). A multivariate analysis identified that the change in ERO was the strongest predictor of peak VO(2) (P = 0.001).
  
  
  CONCLUSIONS
  dynamic changes in MR and LV geometry contributed to the limitation of exercise capacity in patients with CHF.
authors.affiliation: Division of Cardiology, Department of Internal Medicine, St Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Japan. heartizumo@yahoo.co.jp
authors.forename: Masaki
authors.initials: M
authors.lastname: Izumo
authors.forename: Kengo
authors.initials: K
authors.lastname: Suzuki
authors.forename: Marie
authors.initials: M
authors.lastname: Moonen
authors.forename: Seisyou
authors.initials: S
authors.lastname: Kou
authors.forename: Takashi
authors.initials: T
authors.lastname: Shimozato
authors.forename: Akio
authors.initials: A
authors.lastname: Hayashi
authors.forename: Yoshihiro J
authors.initials: YJ
authors.lastname: Akashi
authors.forename: Naohiko
authors.initials: N
authors.lastname: Osada
authors.forename: Kazuto
authors.initials: K
authors.lastname: Omiya
authors.forename: Fumihiko
authors.initials: F
authors.lastname: Miyake
authors.forename: Eiji
authors.initials: E
authors.lastname: Ohtaki
authors.forename: Patrizio
authors.initials: P
authors.lastname: Lancellotti
mesh_terms: D016022:Case-Control Studies; D025401:Echocardiography, Stress; D019560:Echocardiography, Three-Dimensional; D004562:Electrocardiography; D005080:Exercise Test; D005260:Female; D054143:Heart Failure, Systolic / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D011446:Prospective Studies