title: Feasibility of Doppler hemodynamic evaluation of primary and secondary mitral regurgitation during exercise echocardiography.
abstract: Exercise transthoracic echocardiography (ExE) was recently proposed to evaluate tolerance and help risk stratification of mitral regurgitation (MR). Few data are available on the feasibility of Doppler echocardiographic recordings at exercise in daily practice in both secondary and primary MR. Comprehensive resting and ExE were performed in 72 unselected patients (age 59 ± 15 years, 62 % men), with no or minimal symptoms, with at least moderate (mean effective regurgitant orifice area (ERO) = 36 ± 14 mm(2)) primary or secondary MR in two French university hospitals. At rest, quantification of ERO was more challenging in semi-supine position than in classic left lateral decubitus position (55/72; 76 % vs 66/72; 92 %; p = 0.012), particularly in mitral valve (MV) prolapse (35/47; 74 %). During exercise, ERO was only obtained in 30/55 (55 %) patients and was more difficult to assess in MV prolapse than in rheumatic or ischemic MR (respectively in 43, 67 and 88 %, p = 0.046). At peak exercise, ERO was more frequently obtained in symptomatic than asymptomatic patients (77 vs 37 %, p = 0.046) because peak heart rate was lower (113 ± 20 vs 133 ± 23 bpm, p = 0.026). Systolic pulmonary artery pressure (SPAP) was obtained in 69 patients (96 %) at rest and in 60 patients (83 %) at peak exercise (Pex). LV contractile reserve (CR), monitored in all patients (100 %), was found in 51/72 patients (71 %). In daily ExE, monitoring of the CR and SPAP appeared less challenging than MR quantification by the PISA method. Monitoring of ERO was more feasible in ischemic MR than in MV prolapse.
authors.affiliation: Service d'Explorations Fonctionnelles Cardio-Vasculaires, University Hospital of Lille, Lille, France, augustincoisne@hotmail.com.
authors.forename: Augustin
authors.initials: A
authors.lastname: Coisne
authors.forename: Franck
authors.initials: F
authors.lastname: Levy
authors.forename: Dorothée
authors.initials: D
authors.lastname: Malaquin
authors.forename: Marjorie
authors.initials: M
authors.lastname: Richardson
authors.forename: Jean Paul
authors.initials: JP
authors.lastname: Quéré
authors.forename: David
authors.initials: D
authors.lastname: Montaigne
authors.forename: Christophe
authors.initials: C
authors.lastname: Tribouilloy
mesh_terms: D000328:Adult; D000368:Aged; D062186:Arterial Pressure; D058070:Asymptomatic Diseases; D018618:Echocardiography, Doppler, Color; D025401:Echocardiography, Stress / Q000379:methods*; D005080:Exercise Test; D005240:Feasibility Studies; D005260:Female; D005602:France; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging* / Q000503:physiopathology; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D009200:Myocardial Contraction; D056888:Patient Positioning; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011651:Pulmonary Artery / Q000000981:diagnostic imaging / Q000503:physiopathology; D012307:Risk Factors; D012720:Severity of Illness Index; D016683:Supine Position; D016277:Ventricular Function, Left