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. 2005 Nov;91(11):1407-12.
doi: 10.1136/hrt.2004.047613.

Functional and prognostic implications of left ventricular contractile reserve in patients with asymptomatic severe mitral regurgitation

R Lee  1 , B Haluska, D Y Leung, C Case, J Mundy, T H Marwick
Affiliations

Functional and prognostic implications of left ventricular contractile reserve in patients with asymptomatic severe mitral regurgitation

R Lee et al. Heart. 2005 Nov.

Abstract

Objective: To evaluate contractile reserve (CR) determined by exercise echocardiography in predicting clinical outcome and left ventricular (LV) function in asymptomatic severe mitral regurgitation (MR).

Design: Cohort study.

Setting: Regional cardiac centre.

Patients and outcome measures: LV volumes and ejection fraction (EF) were measured at rest and after stress in 71 patients with isolated MR. During follow up (mean (SD) 3 (1) years), EF and functional capacity were serially assessed and cardiac events (cardiac death, heart failure, and new atrial fibrillation) were documented.

Results: CR was present in 45 patients (CR+) and absent in 26 patients (CR-). Age, resting LV dimensions, EF, and MR severity were similar in both groups. Mitral surgery was performed in 19 of 45 (42%) CR+ patients and 22 of 26 (85%) CR- patients. In patients undergoing surgery, CR was an independent predictor of follow up EF (p = 0.006) and postoperative LV dysfunction (EF < 50%) persisted in five patients, all in the CR- group. Event-free survival was lower in surgically treated patients without CR (p = 0.03). In medically treated patients, follow up EF was preserved in those with intact CR but progressively deteriorated in patients without CR, in whom functional capacity also deteriorated.

Conclusions: Evaluation of CR by exercise echocardiography may be useful for risk stratification and may help to optimise the timing of surgery in asymptomatic severe MR.

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Figures

Figure 1
Figure 1
Follow up ejection fraction (EF) in surgically treated patients with (CR+) and without contractile reserve (CR−). EF expressed as mean (SD). *p  =  0.16; †p  =  0.02; ‡p  =  0.008.
Figure 2
Figure 2
Follow up EF in medically treated CR+ and CR− patients. EF expressed as mean (SD). *p  =  0.37; †p  =  0.06.
Figure 3
Figure 3
Comparison of baseline and follow up functional capacity in medically treated CR+ patients.
Figure 4
Figure 4
Event-free survival in surgically treated CR+ and CR− patients.
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