Department of Cardiology, University Hospital Sart Tilman, University of Liège, Liège, Belgium.
J Am Coll Cardiol. 2010 Jul 20;56(4):300-9. doi: 10.1016/j.jacc.2009.12.073.
We sought to quantify exercise-induced changes in patients with degenerative mitral regurgitation (MR), to examine the relationship between exercise-induced changes in MR and in systolic pulmonary artery pressure (PAP), and to identify their potential impact on symptom-free survival.
MR severity can change during exercise in patients with functional MR. Quantified changes in MR severity during exercise remain undetermined in patients with degenerative MR.
Resting and bicycle exercise Doppler-echocardiography were performed in 61 asymptomatic patients (age 62+/-14 years) with moderate to severe degenerative MR (i.e., mitral valve prolapse or flail). Mitral regurgitation was quantified at rest and exercise with effective regurgitant orifice (ERO) area and regurgitant volume calculated with the proximal isovelocity surface area (EROP) and the quantitative Doppler (EROD) methods.
At rest, EROP and EROD were well-correlated (r=0.87, p<0.0001), but EROD was larger than EROP (54+/-21 mm2 vs. 42+/-24 mm2, p<0.0001). During exercise, mean ERO and regurgitant volume markedly increased in 32% of patients by >or=10 mm2 and >or=15 ml, respectively. There was good correlation between exercise EROP and EROD (r=0.84, p<0.0001). Changes in systolic PAP were correlated with changes in ERO and regurgitant volume (r=0.59, p=0.02 and r=0.60, p=0.02). Patients with a marked increase in regurgitant volume during exercise had lower symptom-free survival than those in whom MR decreased or remained unchanged (p=0.0015).
Degenerative MR might be dynamic and increases during exercise in one-third of patients. Marked changes in MR severity are associated with exercise-induced changes in systolic PAP and reduced symptom-free survival.
我们旨在量化退行性二尖瓣反流（MR）患者运动引起的变化，研究MR 变化与收缩期肺动脉压（PAP）变化之间的关系，并确定其对无症状生存的潜在影响。
在功能性 MR 患者中，MR 严重程度可在运动时发生变化。在退行性 MR 患者中，运动时 MR 严重程度的定量变化仍未确定。
对 61 例无症状的中重度退行性 MR 患者（二尖瓣脱垂或连枷）进行静息和踏车超声心动图检查。采用有效反流口面积（ERO）定量计算反流容积和反流速度平面面积（EROP）法测量二尖瓣反流，分别在静息和运动时量化二尖瓣反流。
静息时，EROP 和 EROD 相关性良好（r=0.87，p<0.0001），但 EROD 大于 EROP（54+/-21 mm2 vs. 42+/-24 mm2，p<0.0001）。运动时，32%的患者 ERO 和反流容积分别增加>or=10 mm2 和>or=15 ml。运动时 EROP 和 EROD 相关性良好（r=0.84，p<0.0001）。收缩期 PAP 的变化与 ERO 和反流容积的变化相关（r=0.59，p=0.02 和 r=0.60，p=0.02）。运动时反流容积明显增加的患者无症状生存时间低于 MR 减少或不变的患者（p=0.0015）。
退行性 MR 可能是动态的，三分之一的患者在运动时会增加。MR 严重程度的显著变化与运动引起的 PAP 变化和无症状生存时间缩短有关。
