Exercise does not enhance the prognostic value of Doppler echocardiography in patients with left ventricular systolic dysfunction and functional mitral regurgitation at rest - 08/08/11
, Sylvestre Maréchaux, MD b, e, Clémence Huerre, MD a, Ghislaine Deklunder, MD b, c, Philippe Asseman, MD a, c, Brigitte Jude, MD c, Eric Van Belle, MD a, c, Frédéric Mouquet, MD a, c, Christophe Bauters, MD a, c, Nicolas Lamblin, MD a, Thierry H. LeJemtel, MD d, Pascal de Groote, MD aRésumé |
Background |
Functional mitral regurgitation (MR) is a powerful predictor of poor prognosis in patients with chronic heart failure (CHF) due to left ventricular systolic dysfunction (LVSD). However, severity of MR varies with dynamic exercise. Accordingly, we sought to assess the prognostic value of exercise-induced changes in functional MR in patients with LVSD and functional MR at rest.
Methods |
One hundred four patients with chronic heart failure due to LVSD (ejection fraction [EF] <45%) and functional MR at rest underwent conventional continuous 2-dimensional Doppler echocardiography at rest and during maximal symptom-limited exercise. The primary end point of the study was all-cause mortality. The median follow-up period was 20 months.
Results |
Fifty-six patients (54%) had ischemic cardiomyopathy. When feasible, all 56 patients with ischemic cardiomyopathy had undergone revascularization procedures before enrollment into the study. In the whole patient cohort, resting LV end-diastolic volume was 205 ± 76 mL and EF was 26% ± 9%. Univariate predictors of death were functional class (New York Heart Association), LV EF, LV end-diastolic volume, resting mitral effective regurgitant orifice, mitral E deceleration time, tricuspid annular plane systolic excursion ≤14 mm, systolic blood pressure, LV EF, and trans-tricuspid pressure gradient response to exercise. Exercise-induced change in mitral effective regurgitant orifice did not predict survival (HR 0.99, 95% CI 0.94-1.04, P = .63). By Cox multivariate analysis, resting LV end-diastolic volume and tricuspid annular plane systolic excursion ≤14 mm were the independent predictors of death.
Conclusions |
Exercise Doppler echocardiography does not refine the predictive value of resting Doppler echocardiography in patients with LVSD and functional MR at rest.
Le texte complet de cet article est disponible en PDF.Plan
Vol 155 - N° 4
P. 752-757 - avril 2008 Retour au numéro
Article précédent
- Effects of darbepoetin ? on right and left ventricular systolic and diastolic function in anemic patients with chronic heart failure secondary to ischemic or idiopathic dilated cardiomyopathy
- John T. Parissis, Kallirrhoe Kourea, Fotios Panou, Dimitrios Farmakis, Ioannis Paraskevaidis, Ignatios Ikonomidis, Gerasimos Filippatos, Dimitrios Th. Kremastinos
- Noninvasively determined radial dP/dt is a predictor of mortality in patients with heart failure
- Jean-Michel Tartière, Jean-Yves Tabet, Damien Logeart, Lamia Tartière-Kesri, Florence Beauvais, Christophe Chavelas, Alain Cohen Solal
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?