title: The importance of exercise echocardiography for clinical decision making in primary mitral regurgitation.
abstract: Primary mitral regurgitation is generally an insidious disease with late onset of symptoms. Current European and American guidelines recommend surgery in severe primary mitral regurgitation when symptoms, overt left ventricular dysfunction, pulmonary hypertension or atrial fibrillation, occur. However, recent large studies reported an improved outcome in asymptomatic patients with severe mitral regurgitation referred for early mitral valve repair despite the risk of operative mortality or mitral valve replacement. Moreover, primary mitral regurgitation appears to have an important dynamic character in up to one-third of patients. This article provides an overview of the incremental evidence of the ability of exercise echocardiography to assess the functional repercussions of mitral regurgitation and the identification of high-risk patients who might benefit from early referral for surgery.
authors.affiliation: University of Liege, University Hospital Sart Tilman, Liege, Belgium.
authors.forename: Caroline M
authors.initials: CM
authors.lastname: Van de Heyning
authors.forename: Julien
authors.initials: J
authors.lastname: Magne
authors.forename: Patrizio
authors.initials: P
authors.lastname: Lancellotti
authors.forename: Luc A
authors.initials: LA
authors.lastname: Piérard
mesh_terms: D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D025401:Echocardiography, Stress; D005080:Exercise Test; D006439:Hemodynamics; D006801:Humans; D008943:Mitral Valve / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery; D018579:Patient Selection; D011237:Predictive Value of Tests; D011379:Prognosis; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index