Voß Fabian, Guenther Niklas, Christian Lucas, Zweck Elric, Haschemi Jafer, Schulze Christian, Westenfeld Ralf, Horn Patrick, Kelm Malte, Polzin Amin, Spieker Maximilian
Division of Cardiology, Pulmonology and Vascular Medicine, University Hospital Duesseldorf, Heinrich-Heine University Duesseldorf, Medical Faculty, Moorenstraße 5, 40225 Duesseldorf, Germany.
Division of Cardiology, Vascular Medicine and Intensive Care Medicine, University Hospital Jena, Medical Faculty, Am Klinikum 1, 07747 Jena, Germany.
Int J Cardiol Heart Vasc. 2025 Jun 2;59:101715. doi: 10.1016/j.ijcha.2025.101715. eCollection 2025 Aug.
Recent studies suggest that secondary mitral regurgitation (MR) is a dynamic condition influenced by global and regional left ventricular (LV) remodeling as well as by mitral valvular deformation. Exercise testing is crucial in assessing the hemodynamic relevance of MR and is recommended by current guidelines. However, data are still lacking on the prevalence and prognostic impact of dynamic MR in patients with non-ischemic cardiomyopathy.
We aimed to assess the prevalence, hemodynamic consequences, and prognostic impact of exercise-induced changes in patients with MR and hypokinetic non-dilated and dilated cardiomyopathy.
Patients with hypokinetic non-dilated and dilated cardiomyopathy and at least mild MR who underwent handgrip echocardiography at the University Hospital Duesseldorf between January 2018 and September 2021 were enrolled. Follow-up was performed at one year.
Fifty-eight patients were included (median age 73 [65;81] years; 41 % female; mean LVEF 37 ± 10 %). At rest, 28 patients (48 %) presented with mild MR and 30 patients with moderate MR (52 %). Fifteen patients (26 %) with non-severe MR at rest, developed severe MR during handgrip exercise. Patients with dynamic MR had larger left ventricular volumes, increased mitral annular diameter, and more advanced mitral valve tenting during exercise than those without dynamic MR. Patients with dynamic MR were more likely to undergo MV surgery/interventions (Chi 23.19; log-rank test p < 0.001).
The hemodynamic changes provoked by isometric exercise unmasked dynamic MR in a significant number of patients without severe MR at rest. These data may have implications for therapeutic decision-making in symptomatic patients with non-severe MR at rest.
近期研究表明，继发性二尖瓣反流（MR）是一种动态状态，受左心室（LV）整体和局部重塑以及二尖瓣变形影响。运动试验对于评估MR的血流动力学相关性至关重要，且当前指南推荐进行此项检查。然而，关于非缺血性心肌病患者动态MR的患病率及预后影响的数据仍较为缺乏。
我们旨在评估MR合并运动功能减退的非扩张型和扩张型心肌病患者运动诱发变化的患病率、血流动力学后果及预后影响。
纳入2018年1月至2021年9月在杜塞尔多夫大学医院接受握力超声心动图检查的运动功能减退的非扩张型和扩张型心肌病且至少有轻度MR的患者。随访1年。
共纳入58例患者（中位年龄73[65；81]岁；41%为女性；平均左心室射血分数37±10%）。静息状态下，28例患者（48%）表现为轻度MR，30例患者（52%）表现为中度MR。15例静息时为非重度MR的患者在握力运动期间发展为重度MR。与无动态MR的患者相比，动态MR患者在运动时左心室容积更大、二尖瓣环直径增加且二尖瓣叶帐篷样改变更明显。动态MR患者更有可能接受二尖瓣手术/干预（卡方值23.19；对数秩检验p<0.001）。
等长运动引发的血流动力学变化在大量静息时无重度MR的患者中揭示了动态MR。这些数据可能对静息时非重度MR的有症状患者的治疗决策具有启示意义。
