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European Journal of Echocardiography 2008 9(1):18-25; doi:10.1016/j.euje.2006.11.013
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2007. For permissions please email: journals.permissions@oxfordjournals.org.

Prognostic value of mitral regurgitation assessment during exercise echocardiography in patients with left ventricular dysfunction: A follow-up study of 1.7 ± 1.5 years{dagger}

Jesús Peteiro1,2,3,*, Isaac Bendayan1,2,3, Javier Mariñas3, Rosa Campos1,2,3, Beatriz Bouzas1,2,3 and Alfonso Castro-Beiras1,2,3

1 Unit of Echocardiography, Juan Canalejo Hospital, University of A Coruña, A Coruña, Spain
2 Department of Cardiology, Juan Canalejo Hospital, University of A Coruña, A Coruña, Spain
3 Unit of Codification, Juan Canalejo Hospital, University of A Coruña, A Coruña, Spain

Received 6 August 2006; accepted after revision 26 November 2006; online publish-ahead-of-print 22 January 2007.

* Corresponding author. P/Ronda 5-4° izda.15011-A Coruña, Spain. Tel: +34 81 917859; fax: 34 81 178001. E-mail address: peteiro{at}canalejo.org


  Abstract

Aims: The value of exercise echocardiography (EE) over resting echocardiography when this last incorporates information on mitral regurgitation (MR) is only partially known. Furthermore, limited data exist regarding the value of MR worsening during exercise in patients with left ventricular (LV) dysfunction. We investigate whether EE has incremental value over a resting echo-Doppler study; and whether post-exercise MR increments the value of EE for predicting outcome in patients with LV dysfunction.

Methods and results: Three hundred and twenty-three consecutive patients with LV dysfunction (LV ejection fraction ≤45%) referred for EE were followed for 1.7 ± 1.5 years. There were 43 hard events (myocardial infarction in 9 and cardiac death in 34). Resting MR, peak heart rate x blood pressure, and number of involved territories at exercise were independently associated to hard events (incremental P-value of EE =0.02). Independent variables associated to cardiac death were resting MR, peak heart rate x blood pressure, peak wall motion score index, and MR worsening (incremental P-value of MR worsening = 0.04).

Conclusions: EE maintains its prognostic value over resting echocardiography even when this last incorporates information on MR. Exercise-induced MR worsening has independent prognostic value for cardiac death in patients with LV dysfunction.

Keywords: Exercise echocardiography; Mitral regurgitation; Left ventricular dysfunction

{dagger} Study supported by the Spanish Network of Cardiovascular Studies (RECAVA).


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