title: Clinical significance of exercise pulmonary hypertension in secondary mitral regurgitation.
abstract: In patients with heart failure, exercise echocardiography can help in risk stratification and decision making. The prognostic significance of exercise pulmonary hypertension (PH) in patients with secondary mitral regurgitation (MR) remains unknown. The aim of the present study was to assess the prognostic value of exercise PH in patients with secondary MR and narrow QRS intervals. From 2005 to 2012, 159 consecutive patients with secondary MR, narrow QRS intervals, left ventricular dysfunction (mean ejection fraction 36 ± 7%), and measurable systolic pulmonary arterial pressure (SPAP) during exercise echocardiography were included. Resting and exercise PH were defined as SPAP >50 and >60 mm Hg, respectively. Exercise PH was more frequent than resting PH (40% vs 13%, p <0.0001). On multivariate logistic regression, the independent determinants of exercise PH were resting SPAP (p <0.0001), exercise MR severity (p <0.0001), and e'-wave velocity (p = 0.004). The incidence of cardiac events during follow-up was significantly higher in patients with exercise PH compared with those without exercise PH (4 years: 40 ± 7% vs 20 ± 5%, p <0.0001). Patients with exercise PH exhibited higher rates of cardiac events and death than those with resting PH. In a multivariate Cox proportional hazards model, exercise PH was independently associated with the occurrence of cardiac events (p <0.0001). In conclusion, in patients with secondary MR, exercise PH is determined mainly by resting SPAP, left ventricular diastolic burden, and exercise MR severity. Exercise PH is a powerful predictor of poor outcomes, with a 5.3-fold increased risk for cardiac-related death during follow-up. These results highlight the added value of exercise echocardiography in secondary MR.
authors.affiliation: Department of Cardiology, GIGA Cardiovascular Sciences, Heart Valve Clinic, University Hospital Sart Tilman, University of Liège Hospital, Liège, Belgium; GVM Care and Research, E.S. Health Science Foundation, Lugo (RA), Italy. Electronic address: plancellotti@chu.ulg.ac.be.
authors.forename: Patrizio
authors.initials: P
authors.lastname: Lancellotti
authors.affiliation: Department of Cardiology, GIGA Cardiovascular Sciences, Heart Valve Clinic, University Hospital Sart Tilman, University of Liège Hospital, Liège, Belgium.
authors.forename: Julien
authors.initials: J
authors.lastname: Magne
authors.affiliation: Department of Cardiology, GIGA Cardiovascular Sciences, Heart Valve Clinic, University Hospital Sart Tilman, University of Liège Hospital, Liège, Belgium.
authors.forename: Raluca
authors.initials: R
authors.lastname: Dulgheru
authors.affiliation: Department of Cardiology, GIGA Cardiovascular Sciences, Heart Valve Clinic, University Hospital Sart Tilman, University of Liège Hospital, Liège, Belgium.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Ancion
authors.affiliation: Department of Cardiology, GIGA Cardiovascular Sciences, Heart Valve Clinic, University Hospital Sart Tilman, University of Liège Hospital, Liège, Belgium.
authors.forename: Christophe
authors.initials: C
authors.lastname: Martinez
authors.affiliation: Department of Cardiology, GIGA Cardiovascular Sciences, Heart Valve Clinic, University Hospital Sart Tilman, University of Liège Hospital, Liège, Belgium.
authors.forename: Luc A
authors.initials: LA
authors.lastname: Piérard
mesh_terms: D000368:Aged; D025401:Echocardiography, Stress / Q000379:methods*; D004562:Electrocardiography; D015444:Exercise / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology; D011379:Prognosis; D011669:Pulmonary Wedge Pressure / Q000502:physiology*; D012189:Retrospective Studies; D016277:Ventricular Function, Left / Q000502:physiology*