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Exercise Testing May Help Predict Seriousness of Mitral Regurgitation
December 12, 2007In as many as one in five people over age 55, when the heart contracts to send blood around the body, some degree of backward leakage occurs across the mitral valve, a condition known as mitral regurgitation (MR). When sufficiently severe, MR causes buildup of blood in the lungs, leading to difficulty in breathing (dyspnea, or "shortness of breath"), a serious condition called congestive heart failure. MR also can cause heart rhythm irregularities (arrhythmias) such as atrial fibrillation, which can lead to strokes and other problems, and ventricular tachycardia, which can cause sudden death.
A new study finds that monitoring the capacity of these patients to exercise on a treadmill-an evaluation called exercise tolerance testing (ETT)-may be useful in predicting the condition's progression and whether the patient will need surgery. Led by NewYork-Presbyterian Hospital/Weill Cornell Medical Center, the research is published in the American Journal of Cardiology.
"We found that exercise testing is a simple and relatively inexpensive way to predict outcomes. Patients with mitral regurgitation who perform well on the treadmill will likely remain healthy and not have to undergo further testing for a number of years. This gives these patients peace of mind," says principal investigator Dr. Phyllis G. Supino, associate research professor of public health in medicine and associate research professor of public health at Weill Cornell Medical College.
Developed in its most simple form in the 1920s, exercise tolerance testing (ETT) is used commonly to assess the progression of coronary artery disease and the severity of aortic stenosis.
In mitral regurgitation, the mitral valve does not close completely, as it should, when the heart contracts, allowing blood to flow backward instead of forward, limiting blood flow to the body. Symptoms include shortness of breath, fatigue, cough, heart palpitations, swollen feet or ankles, and excessive urination. A characteristic heart murmur can be heard with a stethoscope.
In the current study, researchers followed 38 patients with chronic severe nonischemic MR (that is, MR not due to a prior heart attack) for an average of seven years. All underwent ETT at study entry. Patients who could continue exercising for 15 minutes or longer (of a maximum total of 18 minutes) had a fivefold lower annual risk of developing heart failure or other evidence of severe heart dysfunction necessitating surgery, compared to patients who were unable to exercise for that length of time.
In patients with chronic severe nonischemic MR, progression to surgical indications generally is rapid. There are two surgical options for the treatment of MR: mitral valve replacement and mitral valve repair.
The study was co-led by Dr. Borer and Dr. Supino. Co-authors included Drs. Clare Hochreiter, Paul Kligfield, Edmund M. Herrold and Jacek J. Preibisz-all of Weill Cornell Medical College; Dr. Anuj Gupta, now at Columbia; and Dr. Karlheinz Schuleri, now at Johns Hopkins University.
Weill Cornell Medical College
Mitral Regurgitation Current Events and Mitral Regurgitation News RSSHalf of eligible patients not getting mitral valve surgery, U-M study shows
Overblown fears about surgical risk and lack of awareness about the risk of not operating are among the reasons only half of eligible patients were referred for mitral valve repair, according to a study by doctors at the University of Michigan Cardiovascular Center.
New way to fix leaking mitral heart valves safe in initial testing
A new nonsurgical technique to repair leaking mitral valves in heart failure patients was safe in a study reported in Circulation: Cardiovascular Interventions.
Evalve MitraClip: Clinical trial of nonsurgical repair for severe mitral valve regurgitation
The Cedars-Sinai Heart Institute is the lead enroller in the world for the Everest II Clinical Trial - a study comparing non-surgical repair for severe mitral valve regurgitation with conventional surgery.
New data shows benefits of MitraClip for patients with mitral regurgitation
The vast majority of patients who had a successful result with the percutaneous MitraClip device did not need mitral valve surgery three years after their procedure, and many benefited from significantly improved function of the left ventricle (commonly known as reverse remodeling).
Percutaneous valve therapy: is it safe and effective?
Researchers at TCT 2007, the annual scientific symposium of the Cardiovascular Research Foundation (CRF), will present new studies evaluating a rapidly advancing field within interventional cardiology: percutaneous procedures to repair and replace defective heart valves.
Mitral valve surgery may be safe option for elderly patients
Deaths among elderly patients undergoing mitral valve surgery have decreased dramatically in recent years - making the procedure a feasible option.
ESC Congress 2003: Left ventricular pacing alone has similar benefits to those of biventricular pacing in patients with severe heart failure
IMPORTANT: This press release accompanies a poster or oral session given at the ESC Congress 2003. Written by the investigator himself/herself, this press release does not necessarily reflect the opinion of the European Society of Cardiology Our study shows that left ventricular and biventricular pacing provide similar improvement of the main mechanisms of benefit of cardiac resynchronisation: synchrony of the left and right ventricle (inter-ventricular synchrony), synchrony of the different segments of the left ventricle (intra-ventricular synchrony), and severity of secondary mitral regurgitation. This might be important from a technical, economical, and safety point of view, since it is e
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