Determinants of exercise-induced increase of mitral regurgitation in patients with acute coronary syndromes

TY - JOUR

T1 - Determinants of exercise-induced increase of mitral regurgitation in patients with acute coronary syndromes

AU - Pecini, Redi

AU - Hammer-Hansen, Sophia

AU - Dalsgaard, Morten

AU - Gøtze, Jens Peter

AU - Hassager, Christian

AU - Køber, Lars

PY - 2010/5/1

Y1 - 2010/5/1

N2 - Background: Mechanisms behind exercise-induced increase of mitral regurgitation (MR) in patients with chronic ischemic heart disease have been described earlier. We describe the determinants of exercise-induced changes in MR in patients with non-ST-elevation acute coronary syndrome (NSTACS). Methods: Forty-five consecutive patients (mean ± SD age 64 ± 10 years, 37 men) with NSTACS underwent exercise echocardiography on a supine bicycle the day before angiography. The exercise was started with a load of 10 W with increments of 10 W every minute until symptoms developed or a max load of 100 W. Effective regurgitation orifice (ERO) was measured at rest and at peak exercise. Results: Twelve patients had more than trace MR at rest with ERO 8 ± 5 (mean ± SD), range: 3-18 mm2. In these patients, ERO increased during exercise to 13 ± 6 (mean ± SD), range: 6-23 mm2 corresponding to an increase of 70% from rest (P = 0.001). Seven other patients developed new MR during exercise with ERO at peak exercise of 8 ± 4 mm2 (mean ± SD), range: 4-14 mm2. All these patients had significant increase in wall motion score index (WMSI) of 0.14 ± 0.18 (mean ± SD), P = 0.006, while in the 25 patients without MR at rest or during exercise, WMSI remained unchanged, -0.02 ± 0.08 (mean ± SD), P = 0.2. Conclusion: Exercise-induced increases of MR in patients with NSTACS are related to worsening of regional wall motions.

AB - Background: Mechanisms behind exercise-induced increase of mitral regurgitation (MR) in patients with chronic ischemic heart disease have been described earlier. We describe the determinants of exercise-induced changes in MR in patients with non-ST-elevation acute coronary syndrome (NSTACS). Methods: Forty-five consecutive patients (mean ± SD age 64 ± 10 years, 37 men) with NSTACS underwent exercise echocardiography on a supine bicycle the day before angiography. The exercise was started with a load of 10 W with increments of 10 W every minute until symptoms developed or a max load of 100 W. Effective regurgitation orifice (ERO) was measured at rest and at peak exercise. Results: Twelve patients had more than trace MR at rest with ERO 8 ± 5 (mean ± SD), range: 3-18 mm2. In these patients, ERO increased during exercise to 13 ± 6 (mean ± SD), range: 6-23 mm2 corresponding to an increase of 70% from rest (P = 0.001). Seven other patients developed new MR during exercise with ERO at peak exercise of 8 ± 4 mm2 (mean ± SD), range: 4-14 mm2. All these patients had significant increase in wall motion score index (WMSI) of 0.14 ± 0.18 (mean ± SD), P = 0.006, while in the 25 patients without MR at rest or during exercise, WMSI remained unchanged, -0.02 ± 0.08 (mean ± SD), P = 0.2. Conclusion: Exercise-induced increases of MR in patients with NSTACS are related to worsening of regional wall motions.

U2 - 10.1111/j.1540-8175.2009.01077.x

DO - 10.1111/j.1540-8175.2009.01077.x

M3 - Journal article

SN - 0742-2822

VL - 27

SP - 567

EP - 574

JO - Echocardiography: A Journal of Cardiovascular Ultrasound and Allied Techniques

JF - Echocardiography: A Journal of Cardiovascular Ultrasound and Allied Techniques

IS - 5

ER -