Determinants of Exercise‐Induced Increase of Mitral Regurgitation in Patients with Acute Coronary Syndromes

Pecini, Redi; Hammer-Hansen, Sophia; Dalsgaard, Morten; Gøtze, Jens Peter; Hassager, Christian; Køber, Lars

doi:10.1111/j.1540-8175.2009.01077.x

Cited by 5 publications

(3 citation statements)

References 27 publications

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“…In 2010, data were published on exercise-induced changes in IMR severity in patients early after acute myocardial infarction [16]. In these patients, IMR severity was associated with a worsened wall motion score with exercise, indicative of more inducible ischemia, particularly involving the inferior and inferoseptal walls.…”

Section: Functional Mr and Imrmentioning

confidence: 97%

Exercise Hemodynamics in Valvular Heart Disease

Booher

Bach

2011

Curr Cardiol Rep

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Exercise hemodynamics play an important role in the evaluation and management of patients with both severe stenotic or regurgitant valve lesions. Exercise testing in patients with valvular heart disease can help to unmask latent symptoms and define the timing of surgical intervention. Additionally, exercise-induced hemodynamics are an important tool to assess prosthetic valve function. This review summarizes both background literature and recent publications that assess the use of exercise hemodynamics in the evaluation and management of valvular heart disease.

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Section: Functional Mr and Imrmentioning

confidence: 97%

Exercise Hemodynamics in Valvular Heart Disease

Booher

Bach

2011

Curr Cardiol Rep

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“…Over the past three decades, the characteristics of dynamic SMR have been studied ( 11 – 13 ). Previous reports have elucidated that changes in LV dyssynchrony, LV sphericity, LV regional wall motion abnormality, increased mitral valve coaptation depth and tenting area, and mitral annular dilatation during exercise are crucial in light of the mechanism of dynamic SMR ( 24 – 32 ). It is worth noting that when comparing ischemic cardiomyopathy with apical and inferobasal scars, the coaptation depth is important in the case of an anterior myocardial infarction while the tenting area and LV regional wall motion abnormality are crucial in the case of an inferior myocardial infarction ( 24 ).…”

Section: Mechanism Of Dynamic Smrmentioning

confidence: 99%

Dynamic Secondary Mitral Regurgitation: Current Evidence and Challenges for the Future

Onishi

Izumo

Naganuma

et al. 2022

Front. Cardiovasc. Med.

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Heart failure (HF) is a challenging situation in healthcare worldwide. Secondary mitral regurgitation (SMR) is a common condition in HF patients with reduced ejection fraction (HFrEF) and tends to be increasingly associated with unfavorable clinical outcomes as the severity of SMR increases. It is worth noting that SMR can deteriorate dynamically under stress. Over the past three decades, the characteristics of dynamic SMR have been studied. Dynamic SMR contributes to the reduction in exercise capacity and adverse clinical outcomes. Current guidelines refer to the indication of transcatheter edge-to-edge repair (TEER) for significant SMR based on data from the Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation (COAPT) trial if symptomatic despite optimal guideline-directed medical therapy (GDMT) and cardiac resynchronization therapy (CRT), but nonpharmacological treatment for dynamic SMR remains challenging. In HFrEF patients with LV dyssynchrony and dynamic SMR, CRT can improve LV dyssynchrony and subsequently attenuate SMR at rest and during exercise. Also, a recent study suggests that TEER with GDMT and CRT is more effective in symptomatic patients with HFrEF and dynamic SMR than GDMT and CRT alone. Further studies are needed to evaluate the safety and efficacy of nonpharmacological treatments for dynamic SMR. In this review, current evidence and challenges for the future of dynamic SMR are discussed.

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“…4) [52,53]. Once myocardial ischemia is excluded [54,55], an acute increase in LV diastolic stiffness and thereby in LV filling pressure during exercise (as estimated from the E/e' ratio [56]) may increase or produce secondary MR owing to mitral leaflet miscoaptation [51]. Several investigators have noted an abnormal LV response to exercise that may exacerbate MR [53,57,58,59,60].…”

Section: Secondary Mr In Hfpefmentioning

confidence: 99%

Secondary Mitral Regurgitation in Heart Failure with Reduced or Preserved Left Ventricular Ejection Fraction

et al. 2013

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Determinants of Exercise‐Induced Increase of Mitral Regurgitation in Patients with Acute Coronary Syndromes

Abstract: Exercise-induced increases of MR in patients with NSTACS are related to worsening of regional wall motions. (Echocardiography 2010;27:567-574).

Cited by 5 publications

References 27 publications

Exercise Hemodynamics in Valvular Heart Disease

Exercise Hemodynamics in Valvular Heart Disease

Dynamic Secondary Mitral Regurgitation: Current Evidence and Challenges for the Future

Secondary Mitral Regurgitation in Heart Failure with Reduced or Preserved Left Ventricular Ejection Fraction

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