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European Heart Journal Advance Access originally published online on December 16, 2005
European Heart Journal 2006 27(6):679-683; doi:10.1093/eurheartj/ehi682
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© The European Society of Cardiology 2005. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Myocardial asynchronism is a determinant of changes in functional mitral regurgitation severity during dynamic exercise in patients with chronic heart failure due to severe left ventricular systolic dysfunction

Pierre V. Ennezat1,2,*, Sylvestre Maréchaux1, Thierry Le Tourneau1, Nicolas Lamblin1, Christophe Bauters1, Eric Van Belle1, Benjamin Gal1, Salem Kacet1, Philippe Asseman1, Ghislaine Deklunder1, Thierry H. LeJemtel2 and Pascal de Groote1

1Cardiology Hospital, Lille, France
2Department of Medicine, Tulane University, New Orleans, LA, USA

Received 9 October 2005; revised 17 November 2005; accepted 24 November 2005; online publish-ahead-of-print 16 December 2005.

* Corresponding author: Intensive Care Unit, University Hospital, Bd Pr Jules Leclercq, 59 000 Lille, France. E-mail address: ennezat{at}yahoo.com

See page 638 for the editorial comment on this article (doi:10.1093/eurheartj/ehi741)

Aims Functional mitral regurgitation (MR) and myocardial asynchronism occur commonly in patients with dilated cardiomyopathy and affect adversely their prognosis and symptoms. The aim of this study was to evaluate the mechanisms of changes in MR severity during dynamic exercise in patients with chronic heart failure (CHF).

Methods and results Seventy patients with CHF due to left ventricular (LV) systolic dysfunction [LV ejection fraction (EF) <40%] and functional MR were studied. All were in sinus rhythm. Medications were left unchanged for the study. Each patient performed a maximal symptom-limited exercise test with continuous 2D-Doppler echocardiography. Mitral regurgitant volume (RV) and effective regurgitant orifice (ERO) were determined at rest and during exercise. LV asynchrony using Doppler tissue imaging and interventricular asynchrony using conventional pulsed-Doppler were evaluated at rest.

Resting LV EF averaged 25±8%. Mean resting LV and interventricular mechanical delays were 56±50 and 43±37 ms, respectively. The overall median values for mitral ERO and RV did not significantly change during dynamic exercise (11 [7–16] vs. 11 [6–21] mm2 and 14 [10–22] vs. 12 [9–23] mL, respectively). However, changes in mitral ERO and RV were individually variable and significantly correlated with the degree of LV asynchronism (r=0.66, P<0.0001 and r=0.66, P<0.0001, respectively).

Conclusion Changes in MR are variable during dynamic exercise. LV asynchronism at rest substantially contributes to worsening of functional MR during dynamic exercise in patients with CHF due to LV systolic dysfunction.

Key Words: Chronic heart failure • Exercise echocardiology • Mitral regurgitation • Myocardial asynchronism


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