April 25, 2026Journal of the American College of Cardiology193 citationsOpen Access
View Full PaperExercise-Induced Changes in Degenerative Mitral Regurgitation
Key Result
A marked increase in regurgitant volume during exercise occurred in 32% of patients with degenerative mitral regurgitation and was associated with reduced symptom-free survival (p=0.0015).
Key Points
- This research aims to quantify how exercise affects mitral regurgitation (MR) and its relationship with pulmonary artery pressure changes and symptom-free survival.
- Sixty-one asymptomatic patients with moderate to severe degenerative MR underwent resting and exercise Doppler-echocardiography.
- Mitral regurgitation was measured using effective regurgitant orifice area and regurgitant volume calculated through specific Doppler methods.
- At rest, EROD was significantly larger than EROP (54±21 mm2 vs. 42±24 mm2, p<0.0001).
- During exercise, 32% of patients experienced marked increases in regurgitant volume (>15 ml) and ERO (>10 mm2).
- Lower symptom-free survival was observed in patients with marked regurgitant volume increases during exercise (p=0.0015).
Study Design
Type
Observational (n=61)
Structured PICO
Do exercise-induced changes in mitral regurgitation severity and systolic pulmonary artery pressure impact symptom-free survival in asymptomatic patients with degenerative MR?
P
Population
61 asymptomatic patients (age 62+/-14 years) with moderate to severe degenerative mitral regurgitation (mitral valve prolapse or flail)
I
Intervention
Bicycle exercise Doppler-echocardiography
C
Comparator
Resting Doppler-echocardiography
O
Outcome
Exercise-induced changes in effective regurgitant orifice (ERO) area, regurgitant volume, systolic pulmonary artery pressure (PAP), and symptom-free survivalsurrogate
Degenerative mitral regurgitation is dynamic, with exercise-induced increases in severity occurring in about one-third of patients and correlating with reduced symptom-free survival.
Main Result
p-value: p=0.0015
Abstract
OBJECTIVES: 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. BACKGROUND: 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. METHODS: 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. RESULTS: At rest, EROP and EROD were well-correlated (r=0.87, por=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). CONCLUSIONS: 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.