Exercise-induced mitral regurgitation is a predictor of morbid events in subjects with mitral valve prolapse

Stoddard, Marcus F.; Prince, Charles R.; Dillon, Susan; Longraker, Rita A.; Morris, Glenn T.; Liddell, Norman E.

doi:10.1016/0735-1097(94)00408-i

Cited by 66 publications

(35 citation statements)

References 44 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Therefore, the data from this study indirectly agree with reports from other studies in both humans and dogs, which suggest that severity of mitral valve regurgitation is a predictor of poor prognosis. 9,28,30 Syncope was related to mortality when all causes of death were considered. Tussive fainting that may occur in conjunction with paroxysm of coughing is common in dogs with chronic pulmonary, bronchial disease, or both.…”

Section: Discussionmentioning

confidence: 99%

Survival Characteristics and Prognostic Variables of Dogs with Mitral Regurgitation Attributable to Myxomatous Valve Disease

Borgarelli

Savarino

Crosara

et al. 2008

Veterinary Internal Medicne

293

369

View full text Add to dashboard Cite

Background: There are few studies evaluating the natural history and prognostic variables in chronic mitral valve disease (CMVI) in a heterogeneous population of dogs.Objectives: To estimate survival and prognostic value of clinical and echocardiographic variables in dogs with CMVI of varying severity. Five hundred and fifty-eight dogs belonging to 36 breeds were studied.Methods: Dogs were included after clinical examination and echocardiography. Long-term outcome was assessed by telephone interview with the owner.Results: The mean follow-up time was 22.7 AE 13.6 months, and the median survival time was 19.5 AE 13.2 months. In univariate analysis, age48 years, syncope, HR4140 bpm, dyspnea, arrhythmias, class of heart failure (International Small Animal Cardiac Health Council), furosemide therapy, end-systolic volume-index (ESV-I)430 mL/m 2 , left atrial to aortic root ratio (LA/Ao)41.7, E wave transmitral peak velocity (Emax)41.2 m/s, and bilateral mitral valve leaflet engagement were associated with survival time when all causes of death were included. For the cardiac-related deaths, all the previous variables except dyspnea and EDV-I4100 mL/m 2 were significantly associated with survival time. Significant variables in multivariate analysis (all causes of death) were syncope, LA/Ao41.7 m/s, and Emax41.2 m/s. For cardiac-related death, the only significant variable was LA/Ao41.7.Conclusions and Clinical Importance: Mild CMVI is a relatively benign condition in dogs. However, some clinical variables can identify dogs at a higher risk of death; these variables might be useful to identify individuals that need more frequent monitoring or therapeutic intervention.

show abstract

Section: Discussionmentioning

confidence: 99%

Survival Characteristics and Prognostic Variables of Dogs with Mitral Regurgitation Attributable to Myxomatous Valve Disease

Borgarelli

Savarino

Crosara

et al. 2008

Veterinary Internal Medicne

293

369

View full text Add to dashboard Cite

show abstract

“…In patients with mitral valve prolapse and no valvular regurgitation at rest, the one third of patients who developed mitral regurgitation during supine cycle ergometry experienced a higher rate of subsequent syncope, heart failure, and progressive valvular regurgitation than those who did not. 42 …”

Section: Valvular Heart Diseasementioning

confidence: 99%

Assessment of Functional Capacity in Clinical and Research Applications

Fleg¹,

Piña²,

Balady³

et al. 2000

Circulation

250

View full text Add to dashboard Cite

A fundamental requirement for many of the activities of daily living is the ability to perform predominantly aerobic, ie, oxygen-using, work. Such activities require the integrated efforts of the heart, lungs, and circulation to deliver oxygen to the metabolically active muscle mass. Thus, the assessment of functional or aerobic exercise time or peak oxygen consumption provides important diagnostic and prognostic information in a wide variety of clinical settings. Furthermore, numerous clinical trials, especially those in patients with heart failure, have used aerobic exercise time or peak oxygen consumption as a primary or secondary end point. This brief advisory will highlight the major clinical and research applications of functional capacity assessment. For a comprehensive review of exercise testing, the reader is referred to the American College of Cardiology/American Heart Association Guidelines for Exercise Testing. 1 Physiology and TerminologyThe maximal capacity of an individual to perform aerobic work is defined by the maximal oxygen consumption (V O 2 max), the product of cardiac output (CO) and arteriovenous oxygen (AV O 2 ) difference at exhaustion. Although V O 2 max is measured in liters per minute, it is usually expressed per kilogram of body weight to facilitate intersubject comparisons. Functional capacity, particularly when estimated rather than measured directly, is often expressed in metabolic equivalents (METs); 1 MET represents resting energy expenditure and approximates 3.5 mL O 2 ⅐ kg Ϫ1 ⅐ min Ϫ1. Because V O 2 max is typically achieved by exercise that involves only about half of the total body musculature, it is generally believed that V O 2 max is limited by maximal CO rather than peripheral factors. 2 V O 2 max is affected by age, sex, conditioning status, and the presence of diseases or medications that influence its components. V O 2 max in a young world-class male endurance athlete can exceed 80 mL ⅐ kg Ϫ1 ⅐ min Ϫ1, whereas a value of 15 mL ⅐ kg Ϫ1 ⅐ min Ϫ1 is typical for a sedentary but healthy 80-year-old woman. Aerobic capacity declines 8% to 10% per decade in nonathletic subjects, 3 mediated largely by decreases in maximal heart rate and AV O 2 difference. Earlier studies suggested that the age-associated decline in V O 2 max may be attenuated to Ϸ5% per decade in endurance-trained subjects who continue to exercise vigorously. However, recent longitudinal observations with Ͼ20 years of follow-up have demonstrated declines of 10% to 15% per decade in such individuals, 4 mediated in part by a reduction in training intensity. At any age, V O 2 max in men is 10% to 20% greater than in women, in part because of a higher hemoglobin concentration, a larger proportion of muscle mass, and a greater stroke volume in men. These age and sex differences in V O 2 max must be considered in interpretations of functional capacity in individuals. Endurance training augments V O 2 max by 10% to 30% primarily by increasing maximal stroke volume and the AV O 2 difference. 5 True V O 2 max is usual...

show abstract

“…104 In patients with mitral valve prolapse and no valvular regurgitation at rest, the one third of patients who developed mitral regurgitation during supine cycle ergometry (evaluated using Doppler echocardiography) experienced a higher rate of subsequent syncope, heart failure, and progressive valvular regurgitation than those who did not. 108 In this instance, exercise testing may assist in identifying individuals at higher risk for future adverse events. Finally, the Center for Medicare and Medicaid Services recently added valvular heart disease to the list of approved indications for cardiac rehabilitation.…”

Section: Inadequate Indication ͼ15mentioning

confidence: 99%

Assessment of Functional Capacity in Clinical and Research Settings

Arena¹,

Myers²,

Williams³

et al. 2007

Circulation

508

219

View full text Add to dashboard Cite

Exercise-induced mitral regurgitation is a predictor of morbid events in subjects with mitral valve prolapse

Abstract: In patients with mitral valve prolapse without mitral regurgitation at rest, exercise provokes mitral regurgitation in 32% of patients and predicts a higher risk for morbid events.

Cited by 66 publications

References 44 publications

Survival Characteristics and Prognostic Variables of Dogs with Mitral Regurgitation Attributable to Myxomatous Valve Disease

Survival Characteristics and Prognostic Variables of Dogs with Mitral Regurgitation Attributable to Myxomatous Valve Disease

Assessment of Functional Capacity in Clinical and Research Applications

Assessment of Functional Capacity in Clinical and Research Settings

Contact Info

Product

Resources

About