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Feasibility of Doppler hemodynamic evaluation of primary and secondary mitral regurgitation during exercise echocardiography

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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 mm2) 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.

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Abbreviations

CR:

Contractile reserve

ERO:

Effective regurgitant orifice area

ExE:

Exercise echocardiography

LV:

Left ventricle

LVEF:

Left ventricular ejection fraction

MR:

Mitral regurgitation

MV:

Mitral valve

Pex:

Peak exercise

PHT:

Pulmonary hypertension

PISA:

Proximal isovelocity surface area

SPAP:

Systolic pulmonary artery pressure

W:

Watts

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Authors and Affiliations

  1. Service d’Explorations Fonctionnelles Cardio-Vasculaires, University Hospital of Lille, Lille, France

    Augustin Coisne, Marjorie Richardson & David Montaigne

  2. INSERM UMR 1011, University Lille 2, Lille, France

    Augustin Coisne & David Montaigne

  3. Department of Cardiology, Amiens University Hospital, Amiens, France

    Franck Levy, Dorothée Malaquin, Jean Paul Quéré & Christophe Tribouilloy

  4. INSERM U 1088 Université de Picardie, Université de Picardie, Amiens, France

    Christophe Tribouilloy

Authors
  1. Augustin Coisne
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  2. Franck Levy
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  3. Dorothée Malaquin
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  4. Marjorie Richardson
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  5. Jean Paul Quéré
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  6. David Montaigne
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  7. Christophe Tribouilloy
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Correspondence to Christophe Tribouilloy.

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Augustin Coisne and Franck Levy have contributed equally to this work.

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Coisne, A., Levy, F., Malaquin, D. et al. Feasibility of Doppler hemodynamic evaluation of primary and secondary mitral regurgitation during exercise echocardiography. Int J Cardiovasc Imaging 31, 291–299 (2015). https://doi.org/10.1007/s10554-014-0550-5

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  • DOI: https://doi.org/10.1007/s10554-014-0550-5

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