Exercise in primary MR patients revealed impaired RV-PC coupling and decreased LA strain during exercise, with strain reductions signaling MR deterioration (p < 0.001).
Does stress echocardiography identify alterations in cardiac mechanics and RV-PC coupling in asymptomatic patients with primary mitral regurgitation compared to healthy controls?
Stress echocardiography reveals impaired cardiac mechanics and RV-PC coupling in asymptomatic primary MR patients, with specific strain alterations identifying those prone to exercise-induced MR worsening.
Absolute Event Rate: 0% vs 0%
Abstract Introduction Mitral regurgitation (MR) is the most common valvular heart disease requiring intervention, often caused by mitral valve degeneration and prolapse. Assessing MR severity relies on echocardiography, but stress echocardiography can uncover early functional impairment. Purpose The study aimed to identify alterations in cardiac mechanics, strain indices, and right ventricular-pulmonary circulation (RV-PC) coupling during exercise in asymptomatic patients with primary MR. Methods 83 participants were included: 63 patients with moderate-to-severe primary MR and 20 healthy controls. All participants underwent comprehensive two-dimensional echocardiography at rest and at peak exercise using a supine bicycle ergometer with increasing workload (increments of 25 W every 3 minutes) until maximal effort or target heart rate was reached; Basic echocardiographic parameters and Strain indices were assessed at rest and at peak workload. Results MR patients had significantly lower exercise duration (8.26 ± 2.32 min vs. 10.32 ± 1.34 min, p 0.001) and peak workload (78.01 ± 21.16 Watt vs. 101.25 ± 9.85 Watt, p 0.001) compared to controls. GLS at peak exercise was significantly lower in MR patients compared to controls (-23.58 ± 3.02% vs. -25.47 ± 3.41%, p = 0.023). Notably, LA contraction strain was the only LA strain parameter significantly different between MR patients and controls at both rest and peak exercise. Among the 63 MR patients who completed the test, 7 exhibited worsening MR severity during exercise. The change in GLS from rest to peak exercise was 2.23 ± 5.25% in the group without MR deterioration, while it was 0.11 ± 4.75% in those who experienced MR worsening (p = NS). LAS reservoir strain increased by 12.60 ± 13.96% in patients without MR deterioration but decreased by -7.78 ± 8.10% in those with MR worsening (p .000). Similarly, LAS conduit strain increased by 5.91 ± 9.98% in the first group but declined by -2.98 ± 2.39% in the latter (p .000), while LAS contraction strain rose by 6.88 ± 7.97% in patients without MR deterioration and fell by -5.47 ± 6.67% in those with MR worsening (p .000). RV free wall strain followed the same trend, increasing by 4.80 ± 7.71% in stable MR patients and decreasing by -2.52 ± 9.01% in those with MR deterioration (p = 0.023). RV 4-chamber strain increased by 4.06 ± 6.75% in the first group and decreased by -1.07 ± 9.69% in the second (p = 0.076). At peak exercise, TAPSE/PASP was significantly lower in MR patients (0.71 ± 0.18mm/mmHg vs. 0.88 ± 0.11mm/mmHg, p .000), as was S’/PASP (0.49 ± 0.14 cm/sec/mmHg vs. 0.65 ± 0.10 cm/sec/mmHg, p .000), indicating impaired RV-PC coupling. Conclusion Stress echocardiography provides valuable insights into cardiac mechanics in MR patients. RV-PC coupling impairment and LAS alterations during exercise may serve as early markers for MR deterioration, supporting the role of dynamic assessments in clinical decision-making.Strain Change Table of Strains and RV-PC coupling
Koukos et al. (Sat,) reported a other. Exercise in primary MR patients revealed impaired RV-PC coupling and decreased LA strain during exercise, with strain reductions signaling MR deterioration (p < 0.001).