Exercise First-Pass Radionuclide Assessment of Left and Right Ventricular Function and Valvular Regurgitation in Symptomatic Mitral Valve Prolapse

Abstract

The changes in right ventricular (RV) and left ventricular (LV) function and in regurgitant fractions on first-pass exercise radionuclide angiography (RNA) were assessed in 29 consecutive patients with symptomatic mitral valve prolapse (MVP). The mean right ventricular ejection fraction (RVEF) was 35 +/- 8% at rest and 46 +/- 15% after exercise (p less than 0.001). The mean left ventricular ejection fraction (LVEF) was 62 +/- 11% at rest and 74 +/- 13% after exercise (p less than 0.001). Seven of 29 patients had an abnormal RV response and 6 had an abnormal LV response. Eight had abnormal wall motion after exercise. A total of 12/29 patients (41%) had one or more abnormalities. The mean left-sided regurgitant fraction before exercise was 27 +/- 17% in 21/29 patients (72%) and 31 +/- 21% after exercise (p = ns). An additional 5 patients (17%) developed left-sided regurgitation after exercise. These findings indicate that wall motion abnormalities and abnormal RVEF and LVEF responses to exercise occur in symptomatic MVP patients. In addition, 26/29 (89.6%) had left-sided regurgitation after exercise. Since the presence of a murmur did not correlate with the presence of mitral regurgitation by RNA, then symptomatic patients with MVP should have first-pass exercise RNA to assess the presence of regurgitation at rest and after exercise. Antibiotic prophylaxis is recommended in MVP patients with systolic murmurs or with regurgitation. Since patients without murmurs can have regurgitation, further study is necessary to determine the need for endocarditis prophylaxis in these patients.

Cardiomyopathy in young adults with classic mitral valve prolapse

“…30 However, these changes in deformations may be the first signs of future deterioration of the left ventricular systolic function by mitral valve prolapse progression. [16][17][18] Moreover, we found aortic root enlargement in young patients with prolapse. Mitral valve prolapse associated with aortic root enlargement is an independent predictor of greater aortic size not only in patients with systemic connective tissue disorders such as Marfan syndrome, but also in the general population.…”

“…Left ventricular contraction abnormalities in symptomatic mitral valve prolapse patients without severe mitral regurgitation but with ventricular arrhythmias have been described in some studies using cardiac tomography, radionuclide angiography, and single-photon emission computed tomography. [16][17][18] Moreover, a marked reduction in the myocardial deformation indices has been demonstrated in patients with degenerative severe mitral regurgitation. 19,20 Two-dimensional speckle-tracking echocardiography is a relatively new technique used for evaluation of the myocardial function.…”

Exercise and Heart Failure

“…Furthermore, the few studies that examined effects of acute exercise on mitral regurgitation have yielded variable results. 139 -146 Although some studies report a decrease in regurgitant volume with acute isotonic exercise, 139,142,144 others show either an increase 143 or no change in the regurgitant volume and fraction. 147,140,141 Thus, there seems to be a wide spectrum of responses to acute bouts of exercise in patients with mitral regurgitation.…”

Systemic Involvement of Connective Tissue and the Heart as Important Characteristics of Primary Mitral Valve Prolapse

“…Вопрос о возможности снижения сократимости при первичном ПМК ставился ранее на основании исследований с использованием компьютерной томографии, радионуклидной ангиографии и одно-фотонной эмиссионной компьютерной томографии [8][9][10]. Было показано снижение показателей дефор-мации миокарда (strain) у пациентов с тяжелой деге-неративной МН [11,12].…”