Data di Pubblicazione:
2014
Citazione:
Impact of dynamic mitral regurgitation on functional capacity in heart failure / F. Bandera, G. Generati, M. Pellegrino, V. Labate, E. Alfonzetti, M. Guazzi. ((Intervento presentato al convegno AHA tenutosi a Chicago nel 2014.
Abstract:
Introduction: In heart failure reduced ejection fraction (HFrEF) patients the severity of mitral regurgitation (MR) at rest has a well-established prognostic value. MR increase during exercise further adds to an increased risk. MR plays a central role in determining pulmonary flow overload and pulmonary hypertension (PH), which is associated with poor prognosis.
Hypothesis: Our aim was to define the relationship between dynamic MR, echocardiographic phenotypes and functional capacity in a cohort of HFrEF patients.
Methods: 102 HFrEF patients (age 65±11; male 71%; ischemic etiology 60%; EF 33±9%; NYHA class I, II, III and IV 21, 34, 36, 9%) underwent cardiopulmonary exercise test (CPET) on tiltable cycle-ergometer (standard incremental ramp protocol) combined with exercise-echocardiography. The population was studied according to the degree of functional MR and data were analyzed looking at CPET- and echo-derived phenotypes.
Results: Study population was divided into three groups according to the degree of functional MR: rest and peak exercise ERO<20 mm2 (Group A); rest ERO<20 mm2 and peak ERO≥20 mm2 (dynamic MR, Group B); rest ERO≥20 mm2 (Group C). The latter group hadhigher resting and peak exercise pulmonary pressure (PAP), an impaired RV systolic function and ventilatory efficiency. Group B patients exhibited a worse exercise response (lower peak VO2 and workload), more advanced cardiac remodeling and higher pulmonary artery systolic pressure (SPAP) compared to Group A, despite similar LVEF.
Conclusions: Dynamic MR is an intermediate condition of the functional MR in HFrEF patients. Exercise-induced MR is associated with a worse CPET phenotype, more unfavorable cardiac chambers remodeling, severe diastolic dysfunction, dynamic PHand RV dysfunction. A combined approach with CPET and echocardiographic assessment can help to early unmask and treatfunctional dynamic MR and its unfavorable phenotypes.
Tipologia IRIS:
14 - Intervento a convegno non pubblicato
Elenco autori:
F. Bandera, G. Generati, M. Pellegrino, V. Labate, E. Alfonzetti, M. Guazzi
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