title: Impact of duration of mitral regurgitation on outcomes in asymptomatic patients with myxomatous mitral valve undergoing exercise stress echocardiography.
abstract: BACKGROUND
  Significant mitral regurgitation (MR) typically occurs as holosystolic (HS) or mid-late systolic (MLS), with differences in volumetric impact on the left ventricle (LV). We sought to assess outcomes of degenerative MR patients undergoing exercise echocardiography, separated based on MR duration (MLS versus HS).
  
  
  RESULTS
  We included 609 consecutive patients with ≥III+myxomatous MR undergoing exercise echocardiography: HS (n=487) and MLS (n=122). MLS MR was defined as delayed appearance of MR signal during mid-late systole on continuous-wave Doppler while HS MR occurred throughout systole. Composite events of death and congestive heart failure were recorded. Compared to MLS MR, HS MR patients were older (60±14 versus 53±14 years), more were males (72% versus 53%), and had greater prevalence of atrial fibrillation (16% versus 7%; all P<0.01). HS MR patients had higher right ventricular systolic pressure (RVSP) at rest (33±11 versus 27±9 mm Hg), more flail leaflets (36% versus 6%), and a lower number of metabolic equivalents (METs) achieved (9.5±3 versus 10.5±3), compared to the MLS MR group (all P<0.05). There were 54 events during 7.1±3 years of follow-up. On step-wise multivariable analysis, HS versus MLS MR (HR 4.99 [1.21 to 20.14]), higher LV ejection fraction (hazard ratio [HR], 0.94 [0.89 to 0.98]), atrial fibrillation (HR, 2.59 [1.33 to 5.11]), higher RVSP (HR, 1.05 [1.03 to 1.09]), and higher percentage of age- and gender-predicted METs (HR, 0.98 [0.97 to 0.99]) were independently associated with adverse outcomes (all P<0.05).
  
  
  CONCLUSIONS
  In patients with ≥III+myxomatous MR undergoing exercise echocardiography, holosystolic MR is associated with adverse outcomes, independent of other predictors.
authors: Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH (P.N., F.A., T.B., L.R., R.A.G., S.A., J.D.T., M.G., T.M., B.P.G., M.Y.D.).
authors: Peyman
authors: P
authors: Naji
authors: Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH (P.N., F.A., T.B., L.R., R.A.G., S.A., J.D.T., M.G., T.M., B.P.G., M.Y.D.).
authors: Fadi
authors: F
authors: Asfahan
authors: Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH (P.N., F.A., T.B., L.R., R.A.G., S.A., J.D.T., M.G., T.M., B.P.G., M.Y.D.).
authors: Tyler
authors: T
authors: Barr
authors: Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH (P.N., F.A., T.B., L.R., R.A.G., S.A., J.D.T., M.G., T.M., B.P.G., M.Y.D.).
authors: L Leonardo
authors: LL
authors: Rodriguez
authors: Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH (P.N., F.A., T.B., L.R., R.A.G., S.A., J.D.T., M.G., T.M., B.P.G., M.Y.D.).
authors: Richard A
authors: RA
authors: Grimm
authors: Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH (P.N., F.A., T.B., L.R., R.A.G., S.A., J.D.T., M.G., T.M., B.P.G., M.Y.D.).
authors: Shikhar
authors: S
authors: Agarwal
authors: Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH (P.N., F.A., T.B., L.R., R.A.G., S.A., J.D.T., M.G., T.M., B.P.G., M.Y.D.).
authors: James D
authors: JD
authors: Thomas
authors: Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH (P.N., F.A., T.B., L.R., R.A.G., S.A., J.D.T., M.G., T.M., B.P.G., M.Y.D.).
authors: A Marc
authors: AM
authors: Gillinov
authors: Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH (P.N., F.A., T.B., L.R., R.A.G., S.A., J.D.T., M.G., T.M., B.P.G., M.Y.D.).
authors: Tomislav
authors: T
authors: Mihaljevic
authors: Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH (P.N., F.A., T.B., L.R., R.A.G., S.A., J.D.T., M.G., T.M., B.P.G., M.Y.D.).
authors: Brian P
authors: BP
authors: Griffin
authors: Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH (P.N., F.A., T.B., L.R., R.A.G., S.A., J.D.T., M.G., T.M., B.P.G., M.Y.D.).
authors: Milind Y
authors: MY
authors: Desai
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology; D015150:Echocardiography, Doppler; D025401:Echocardiography, Stress / Q000379:methods*; D015444:Exercise; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000503:physiopathology; D008944:Mitral Valve Insufficiency / Q000150:complications* / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology*; D008945:Mitral Valve Prolapse / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology*; D011379:Prognosis; D012720:Severity of Illness Index; D013997:Time Factors; D016277:Ventricular Function, Left
keywords: mitral regurgitation duration; stress echocardiography and outcomes