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European Heart Journal Advance Access published online on July 29, 2005
European Heart Journal, doi:10.1093/eurheartj/ehi431
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European Heart Journal © The European Society of Cardiology 2005; all rights reserved
Received February 6, 2005
Revised June 24, 2005
Accepted June 30, 2005

Clinical research

Exercise-induced changes in mitral regurgitation in patients with prior myocardial infarction and left ventricular dysfunction: relation to mitral deformation and left ventricular function and shape

Vojislav Giga 1, Miodrag Ostojic 1*, Bosiljka Vujisic-Tesic 1, Ana Djordjevic-Dikic 1, Jelena Stepanovic 1, Branko Beleslin 1, Milan Petrovic 1, Milan Nedeljkovic 1, Ivana Nedeljkovic 1, and Natasa Milic 1

1 Department for Diagnostic and Catheterization Laboratories, Institute for Cardiovascular Disease, Clinical Center of Serbia, 8 Koste Todorovica, 11000 Belgrade, Yugoslavia

* To whom correspondence should be addressed.
Miodrag Ostojic, E-mail: miodrag.ostojic{at}kcs.ac.yu


  Abstract

Aims The aim of this study was to assess the relationship between exercise-induced changes in mitral regurgitation (MR) and echocardiographic characteristics of mitral deformation, global left ventricular (LV) function and shape at rest and after exercise.

Methods and results Forty consecutive patients with ischaemic MR due to prior myocardial infarction (MI), ejection fraction < 45% in sinus rhythm underwent exercise-echocardiographic testing. Exercise-induced changes in effective regurgitant orifice (ERO) were compared with baseline and exercise-induced changes in mitral deformation and global LV function and shape. There was significant correlation between exercise-induced changes in ERO and changes in coaptation distance (r = 0.80, P < 0.0001), tenting area (r = 0.79, P < 0.0001) and mitral annular diameter (r = 0.65, P < 0.0001), as well as in end-systolic sphericity index (r = -0.50, P = 0.001, respectively), and wall motion score index (r = 0.44, P = 0.004). In contrast, exercise-induced changes in ERO were not related to the echocardiographic features at rest. By stepwise multiple regression model, the exercise-induced changes in mitral deformation were found to independently correlate with exercise-induced changes in ERO (generalized r2 = 0.80, P < 0.0001).

Conclusion Exercise-induced changes in severity of ischaemic MR in patients with LV dysfunction due to prior MI were independently related to changes in mitral deformation.

Keywords: Mitral regurgitation; Exercise; Left ventricular dysfunction.
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