Mi-Hyang Jung1, Hae Ok Jung1, Jung-Won Lee1, Ho-Joong Youn1. 1. Division of Cardiology, Department of Internal Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.
Abstract
BACKGROUND: Doppler-driven net atrioventricular compliance (Cn ), which represents left atrial (LA) compliance, is an important determinant of pulmonary hypertension in mitral stenosis (MS). HYPOTHESIS: We hypothesized that decreases in Cn during early-stage exercise underlie exercise intolerance in patients with MS. METHODS: Thirty-three asymptomatic patients with significant MS (valve area 1.24 ± 0.16 cm2 ) underwent resting and bicycle exercise echocardiography. LA compliance and conventional parameters were assessed at each workload. The patients were classified into two groups based on whether they developed dyspnea during exercise: an exercise-intolerance group (n = 22) and an exercise-tolerance group (n = 11). Moreover, "50 W" was defined as an early exercise stage. RESULTS: Although the groups had similar resting characteristics, there were striking differences in their echocardiographic parameters from the early stages of exercise. The relative Cn decrease at 50 W (expressed as a percentage of the resting Cn ) was significantly greater in the exercise-intolerance group (70.3 ± 15.4% vs 49.7 ± 9.7%, P < .001). The overall decrease in relative Cn was significantly greater in the exercise-intolerance group (P = .0005). Furthermore, differences in the trends in this parameter were observed between the two groups (P < .0001 for interaction). Multivariate analysis revealed that the relative Cn decrease at 50 W was an independent predictor of exercise intolerance (adjusted OR 1.105, 95% CI 1.030-1.184) after adjustment for other conventional parameters. CONCLUSIONS: Decreases in Cn during early-stage exercise are an important mechanism underlying exercise intolerance in MS.
BACKGROUND: Doppler-driven net atrioventricular compliance (Cn ), which represents left atrial (LA) compliance, is an important determinant of pulmonary hypertension in mitral stenosis (MS). HYPOTHESIS: We hypothesized that decreases in Cn during early-stage exercise underlie exercise intolerance in patients with MS. METHODS: Thirty-three asymptomatic patients with significant MS (valve area 1.24 ± 0.16 cm2 ) underwent resting and bicycle exercise echocardiography. LA compliance and conventional parameters were assessed at each workload. The patients were classified into two groups based on whether they developed dyspnea during exercise: an exercise-intolerance group (n = 22) and an exercise-tolerance group (n = 11). Moreover, "50 W" was defined as an early exercise stage. RESULTS: Although the groups had similar resting characteristics, there were striking differences in their echocardiographic parameters from the early stages of exercise. The relative Cn decrease at 50 W (expressed as a percentage of the resting Cn ) was significantly greater in the exercise-intolerance group (70.3 ± 15.4% vs 49.7 ± 9.7%, P < .001). The overall decrease in relative Cn was significantly greater in the exercise-intolerance group (P = .0005). Furthermore, differences in the trends in this parameter were observed between the two groups (P < .0001 for interaction). Multivariate analysis revealed that the relative Cn decrease at 50 W was an independent predictor of exercise intolerance (adjusted OR 1.105, 95% CI 1.030-1.184) after adjustment for other conventional parameters. CONCLUSIONS: Decreases in Cn during early-stage exercise are an important mechanism underlying exercise intolerance in MS.
Authors: Francesco Bandera; Anita Mollo; Matteo Frigelli; Giulia Guglielmi; Nicoletta Ventrella; Maria Concetta Pastore; Matteo Cameli; Marco Guazzi Journal: Front Cardiovasc Med Date: 2022-01-13
Authors: Joanna B Hrabia; Elahn P L Pogue; Alexander G Zayachkowski; Dorota Długosz; Olga Kruszelnicka; Andrzej Surdacki; Bernadeta Chyrchel Journal: Postepy Kardiol Interwencyjnej Date: 2018-06-19 Impact factor: 1.426