Mitral regurgitation in heart failure: insights from CPET combined with exercise echocardiography

被引:23
作者
Bandera, Francesco [1 ]
Generati, Greta [1 ]
Pellegrino, Marta [1 ]
Garatti, Andrea [2 ]
Labate, Valentina [1 ]
Alfonzetti, Eleonora [1 ]
Gaeta, Maddalena [3 ]
Castelvecchio, Serenella [2 ]
Menicanti, Lorenzo [2 ]
Guazzi, Marco [1 ]
机构
[1] Univ Milan, Univ Cardiol Dept, Cardiopulm Lab, IRCCS Policlinico San Donato, Milan, Italy
[2] IRCCS Policlin San Donato, Dept Cardiac Surg, Milan, Italy
[3] Univ Pavia, Dept Publ Hlth Expt & Forens Med, Unit Biostat & Clin Epidemiol, Pavia, Italy
关键词
heart failure; functional mitral regurgitation; pulmonary hypertension; right ventricle; exercise echocardiography; VENTRICULAR SYSTOLIC DYSFUNCTION; PROGNOSTIC-SIGNIFICANCE; PULMONARY-HYPERTENSION; DETERMINANTS; VENTILATION; MORTALITY; CAPACITY;
D O I
10.1093/ehjci/jew096
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Aims In heart failure patients with reduced ejection fraction (HFrEF), exercise-induced functional mitral regurgitation (MR) may affect functional capacity and outcome. We sought to study functional and cardiac phenotypes of HFrEF patients according to the MR degree. Methods and results We performed rest and exercise echocardiography (Ex-Echo), simultaneously combined with cardiopulmonary exercise test (CPET), in 102 HFrEF patients, identifying 3 groups: non-severe (ERO < 20 mm(2)) MR (group A), exercise-induced severe (ERO >= 20 mm2) MR (group B), and rest severe MR (group C). Patients were tracked for the composite end point of death and heart failure hospitalization. Group B (ERO: rest = 14 +/- 5 mm(2), Ex = 28 +/- 6 mm(2); P < 0.001) had a functional impairment (workload = 56 +/- 21 vs. 50 +/- 17 watts, P = 0.42; peak VO2 = 11.8 +/- 3.2 vs. 11.5 +/- 3.0 mL/Kg/min, P = 0.70) similar to Group C (ERO: rest = 29 +/- 7 mm(2), Ex = 42 +/- 7 mm(2), P = < 0.001), associated with comparable advanced left ventricle remodelling (end diastolic indexed volume = 107 +/- 34 vs. 115 +/- 30 mL/m(2), P = 0.27), characterized by exercise-induced pulmonary hypertension (PH) (Ex systolic pulmonary pressures = 63 +/- 16 mmHg). Group C showed the worse cardiac phenotype (right ventricle dilatation, dysfunction, and rest PH) with severe ventilatory impairment (VE/VCO2 = 41.2 +/- 11) compared with Groups A and B. Moreover, Group C had the higher rate of death and HF hospitalization. Conclusions In HFrEF patients, severe dynamic MR produces functional limitation similar to rest severe MR, characterized by dynamic PH. Rest severe MR reflects the most advanced bi-ventricular remodelling associated with rest PH, the most unfavourable ventilatory profile, and the worst mid-term outcome.
引用
收藏
页码:296 / 303
页数:8
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