Prognostic value of exercise tolerance testing in asymptomatic chronic nonischemic mitral regurgitation.

Prognostic value of exercise tolerance testing in asymptomatic chronic nonischemic mitral regurgitation. Research Abstract Details 

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Prognostic value of exercise tolerance testing in asymptomatic chronic nonischemic mitral regurgitation. Abstract Text:

Phyllis G Supino,Jeffrey S Borer,Karlheinz Schuleri,Anuj Gupta,Clare Hochreiter,Paul Kligfield,Edmund McM Herrold,Jacek J Preibisz,Phyllis G Supino,Jeffrey S Borer,Karlheinz Schuleri,Anuj Gupta,Clare Hochreiter,Paul Kligfield,Edmund McM Herrold,Jacek J Preibisz,

In many heart diseases, exercise tolerance testing (ETT) has useful functional correlates and/or prognostic value. However, its predictive value in mitral regurgitation (MR) is undefined. To determine whether ETT descriptors predict death or indications for mitral valve surgery in patients with MR, we prospectively followed, for 7 +/- 3 end-point-free years, a cohort of 38 patients with chronic severe nonischemic MR who underwent modified Bruce ETT; all lacked surgical indications at study entry. Their baseline exercise descriptors were also compared with those from 46 patients with severe MR who, at entry, already had reached surgical indications. End points during follow-up in the cohort included sudden death (n = 1), heart failure symptoms (n = 2), atrial fibrillation (n = 4), left ventricular (LV) ejection fraction <60% (n = 2), LV systolic dimensions > or =45 mm (n = 12) and >40 mm (n = 11), LV ejection fraction <60% plus LV systolic dimensions > or =45 mm (n = 3), and heart failure plus LV systolic dimensions > or =45 mm plus LV ejection fraction <60% (n = 1). In univariate analysis, exercise duration (p = 0.004), chronotropic response (p = 0.007), percent predicted peak heart rate (p = 0.01), and heart rate recovery (p <0.02) predicted events; in multivariate analysis, only exercise duration was predictive (p <0.02). Average annual event risk was fivefold lower (4.62%) with an exercise duration > or =15 versus <15 minutes (average annual risk 23.48%, p = 0.004). Relative risks in patients with and without exercise-inducible ST-segment depression were comparable (< or =1.3, p = NS) whether defined at entry and/or during follow-up. Exercise duration, but not prevalence of exercise-inducible ST-segment depression, was lower (p <0.001) in patients with surgical indications at entry versus initially end-point-free patients. In conclusion, in asymptomatic patients with chronic severe nonischemic MR and no objective criteria for operation, progression to surgical indications generally is rapid. However, those with excellent exercise tolerance have a relatively benign course. Exercise-inducible ST-segment depression has no prognostic value in this population.

Prognostic value of exercise tolerance testing in asymptomatic chronic nonischemic mitral regurgitation. Publishing Authors By Initials

PG Supino,JS Borer,K Schuleri,A Gupta,C Hochreiter,P Kligfield,EM Herrold,JJ Preibisz,PG Supino,JS Borer,K Schuleri,A Gupta,C Hochreiter,P Kligfield,EM Herrold,JJ Preibisz,

For similar investigative techniques: epidemiologic methods: epidemiologic study characteristics as topic: epidemiologic studies: cohort studies: longitudinal studies: prospective studies research abstracts see: investigative techniques: epidemiologic methods: epidemiologic study characteristics as topic: epidemiologic studies: cohort studies: longitudinal studies: prospective studies research

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Prognostic value of exercise tolerance testing in asymptomatic chronic nonischemic mitral regurgitation. Journal Published:

PUBLICATION TYPE: Research Support, Non-U.S. Gov

Journal: The American journal of cardiology

VOLUME: 100

Page Numbers: 1274-81

Journal Abbreviation: Am. J. Cardiol.

ISSN: 0002-9149

DAY: 23

MONTH: 07

YEAR: 2007

Prognostic value of exercise tolerance testing in asymptomatic chronic nonischemic mitral regurgitation. Information

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LANGUAGE: eng

NlmUniqueID: 207277

Prognostic value of exercise tolerance testing in asymptomatic chronic nonischemic mitral regurgitation. Keywords Mesh Terms:

KEYWORDS: Prospective Studies

MESH TERMS: ultrasonography

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Grant and Affiliation Information for Prognostic value of exercise tolerance testing in asymptomatic chronic nonischemic mitral regurgitation.

AFFILIATION: Department of Medicine, Weill Cornell Medical College, New York, NY, USA.

Country: United States

AGENCY: United States NHLBI

GRANT: R01 HL 26504

ACRONYM: HL

MEDLINETA: Am J Cardiol

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