title: Determinants of functional capacity after mitral valve annuloplasty or replacement for ischemic mitral regurgitation.
abstract: OBJECTIVE
  To identify the exercise echocardiographic determinants of long-term functional capacity, in patients with chronic ischemic mitral regurgitation, after restrictive mitral valve annuloplasty (RMA) or mitral valve replacement (MVR).
  
  
  METHODS
  We retrospectively analyzed 121 patients with significant chronic ischemic mitral regurgitation, who underwent RMA (n = 62) or MVR (n = 59), between 2005 and 2011. Preoperatively, all patients underwent a resting echocardiographic examination, and a 6-minute walking test (6-MWT) to measure distance. Resting and exercise stress echocardiography, and the 6-MWT were repeated at 41 ± 16.5 months.
  
  
  RESULTS
  After surgery, the 6-MWT distance significantly improved in the MVR group, and decreased in the RMA group (+37 ± 39 m vs -24 ± 49 m, respectively; P < .0001). Exercise indexed effective orifice area was significantly higher in the MVR, versus the RMA, group (MVR: change from 1.3 ± 0.2 cm(2)/m(2) to 1.5 ± 0.3 cm(2)/m(2); RMA: change from 1.1 ± 0.3 cm(2)/m(2) to 1.2 ± 0.3 cm(2)/m(2); P = .001). The mean mitral gradients significantly increased from rest to exercise, in both groups, but to a greater extent in the RMA group (change from 4.4 ± 1.4 to 11 ± 3.6 mm Hg; MVR: change from 4.3 ± 1.8 to 9 ± 3.5 mm Hg; P = .006). On multivariate analysis, MVR and exercise indexed effective orifice area were the main independent determinants of postoperative 6-MWT. In the RMA group, 25 patients experienced late mitral regurgitation recurrence, severe in 9 (14%) of them. The rate of postoperative cardiovascular events was significantly higher in the RMA group (21% vs MVR: 8%; P = .03). Follow-up survival was 83% in the RMA group and 88% in the MVR group (P = .54).
  
  
  CONCLUSIONS
  For chronic ischemic mitral regurgitation, MVR versus RMA was associated with better postoperative exercise hemodynamic performance and long-term functional capacity.
authors.affiliation: Cardiovascular Department, Ospedale Papa Giovanni XXIII, Bergamo, Italy; Bristol Heart Institute, University of Bristol, Bristol, United Kingdom.
authors.forename: Carlo
authors.initials: C
authors.lastname: Fino
authors.affiliation: Cardiovascular Department, Ospedale Papa Giovanni XXIII, Bergamo, Italy.
authors.forename: Attilio
authors.initials: A
authors.lastname: Iacovoni
authors.affiliation: Cardiovascular Department, Ospedale Papa Giovanni XXIII, Bergamo, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Ferrero
authors.affiliation: Cardiovascular Department, Ospedale Papa Giovanni XXIII, Bergamo, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Merlo
authors.affiliation: Cardiovascular Department, Ospedale Papa Giovanni XXIII, Bergamo, Italy.
authors.forename: Diego
authors.initials: D
authors.lastname: Bellavia
authors.affiliation: Cardiovascular Department, Ospedale Papa Giovanni XXIII, Bergamo, Italy.
authors.forename: Emilia
authors.initials: E
authors.lastname: D'Elia
authors.affiliation: Bristol Heart Institute, University of Bristol, Bristol, United Kingdom.
authors.forename: Antonio
authors.initials: A
authors.lastname: Miceli
authors.affiliation: Cardiovascular Department, Ospedale Papa Giovanni XXIII, Bergamo, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Senni
authors.affiliation: Bristol Heart Institute, University of Bristol, Bristol, United Kingdom.
authors.forename: Massimo
authors.initials: M
authors.lastname: Caputo
authors.affiliation: Cardiovascular Department, Ospedale Papa Giovanni XXIII, Bergamo, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Ferrazzi
authors.affiliation: Cardiovascular Department, Ospedale Papa Giovanni XXIII, Bergamo, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Galletti
authors.affiliation: Cardiology Department, Hôpital Dupuytren, Le Centre Hospitalier et Universitaire de Limoges (CHU Limoges), Limoges, France. Electronic address: Jul.magne@yahoo.fr.
authors.forename: Julien
authors.initials: J
authors.lastname: Magne
mesh_terms: D000368:Aged; D002908:Chronic Disease; D015150:Echocardiography, Doppler; D025401:Echocardiography, Stress; D005080:Exercise Test; D017079:Exercise Tolerance; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D058386:Mitral Valve Annuloplasty / Q000009:adverse effects; D008944:Mitral Valve Insufficiency / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D017202:Myocardial Ischemia / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D011237:Predictive Value of Tests; D020127:Recovery of Function; D012008:Recurrence; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D016138:Walking
keywords: Chronic ischemic mitral regurgitation; echocardiography; exercise; functional capacity; mitral valve surgery