Exercise-induced changes in mitral regurgitation in patients with prior myocardial infarction and left ventricular dysfunction: relation to mitral deformation and left ventricular function and shape

Giga, Vojislav; Ostojić, Miodrag; Vujisić-Tešić, Bosiljka; Djordjevic‐Dikic, Ana; Stepanović, Jelena; Beleslin, Branko; Petrović, Milan; Nedeljković, Milan; Nedeljković, Ivana; Milić, Nataša

doi:10.1093/eurheartj/ehi431

Cited by 60 publications

(45 citation statements)

References 33 publications

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“…3) is likely determined by the complex interaction between mitral valve leaflets, mitral annulus dimension, LA compliance and pressure, LV systolic dimension, function, pressure, and chronotropy and the exercise-induced changes in these parameters. 23,25 The strongest correlation is observed with changes in the mitral valve configuration. The increase in EROA during exercise results from bulging in the systolic tenting area (the area enclosed between the mitral leaflets and the annulus plane), an increase in coaptation distance (apical displacement of the coaptation leaflet tips), and a systolic expansion of the mitral annulus.…”

Section: Dynamic Secondary Mr: Determinants and Mechanismsmentioning

confidence: 97%

Stress Echocardiography and Mitral Valvular Heart Disease

2013

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Section: Dynamic Secondary Mr: Determinants and Mechanismsmentioning

confidence: 97%

Stress Echocardiography and Mitral Valvular Heart Disease

2013

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“…Following an anterior wall myocardial infarction extending to the apical segments of the inferior wall, patients show more apically tethered mitral leaflets, with coaptation depth being a determinant of exercise-induced MR deterioration 51, 52 . In patients with inferior wall infarction on the other hand, regional wall motion abnormalities during exercise tether the mitral valve more posteriorly, frequently restricting in particular the posterior leaflet, and increasing the annular dimension (in particular around P2–P3), thereby aggravating MR in a somewhat different way.…”

Section: Pathophysiologymentioning

confidence: 99%

Exercise Dynamics in Secondary Mitral Regurgitation

et al. 2017

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Secondary mitral valve regurgitation (MR) remains a challenging problem in the diagnostic work-up and treatment of heart failure patients. Although secondary MR is characteristically dynamic in nature and sensitive to changes in ventricular geometry and loading, current therapy is mainly focused on resting conditions. Exercise-induced increase in secondary MR, however, is associated with impaired exercise capacity and increased mortality. In an era where a multitude of percutaneous solutions are emerging for the treatment of HF patients it becomes important to address the dynamic component of secondary MR during exercise as well. A critical reappraisal of the underlying disease mechanisms, and in particular of the dynamic component during exercise is of timely importance. This review summarizes the pathophysiologic mechanisms involved in the dynamic deterioration of secondary MR during exercise, its functional and prognostic impact, and the way current treatment options affect the dynamic lesion and exercise hemodynamics in general.

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“…The primary determinants of exercise-related deterioration in MR appear to be systolic annular area, degree of tenting of the valve and the associated wall motion abnormalities (42). These are dependent on the extent of ischaemic damage, exercise-induced dyssynchrony and the presence or absence of viability within the myocardium and papillary muscles; indeed, the severity of MR may reduce in patients with viable myocardium due to myocardial recruitment (43, 44, 45). Whether secondary MR improves or deteriorates on exercise is important as an increase in severity of MR with exercise by EROA ≥13 mm 2 is associated with a five-fold increased risk of subsequent cardiac death (46).…”

Section: Secondary Mrmentioning

confidence: 99%

Timing surgery in mitral regurgitation: defining risk and optimising intervention using stress echocardiography

Liu

Edwards

Ray³

et al. 2016

Echo Res Pract

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Mitral regurgitation (MR) is the second most common form of valvular disease requiring surgery. Correct identification of surgical candidates and optimising the timing of surgery are key in management. For primary MR, this relies upon a balance between the peri-operative risks and rates of successful repair in patients undergoing early surgery when asymptomatic with the potential risk of irreversible left ventricular dysfunction if intervention is performed too late. For secondary MR, recognition that this is a highly dynamic condition where MR severity may change is key, although data on outcomes in determining whether concomitant valve intervention is performed with revascularisation has raised questions regarding timing of surgery. There has been substantial interest in the use of stress echocardiography to risk stratify patients in mitral regurgitation. This article reviews the role of stress echocardiography in both primary and secondary mitral regurgitation and discusses how this can help clinicians tackle the challenges of this prevalent condition.

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Exercise-induced changes in mitral regurgitation in patients with prior myocardial infarction and left ventricular dysfunction: relation to mitral deformation and left ventricular function and shape

Abstract: Exercise-induced changes in severity of ischaemic MR in patients with LV dysfunction due to prior MI were independently related to changes in mitral deformation.

Cited by 60 publications

References 33 publications

Stress Echocardiography and Mitral Valvular Heart Disease

Stress Echocardiography and Mitral Valvular Heart Disease

Exercise Dynamics in Secondary Mitral Regurgitation

Timing surgery in mitral regurgitation: defining risk and optimising intervention using stress echocardiography

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