Pulmonary Arterial Pressure Detects Functional Mitral Stenosis After Annuloplasty for Primary Mitral Regurgitation: An Exercise Stress Echocardiographic Study Publisher Pubmed



Samiei N¹ ; Tajmirriahi M² ; Rafati A¹ ; Pasebani Y¹ ; Rezaei Y¹ ; Hosseini S¹
Source: Echocardiography Published:2018

Abstract

Introduction: The restrictive mitral valve annuloplasty (RMA) is the treatment of choice for degenerative mitral regurgitation (MR), but postoperative functional mitral stenosis remains a matter of debate. In this study, we sought to determine the impact of mitral stenosis on the functional capacity of patients. Methods: In a cross-sectional study, 32 patients with degenerative MR who underwent RMA using a complete ring were evaluated. All participants performed treadmill exercise test and underwent echocardiographic examinations before and after exercise. Results: The patients’ mean age was 50.1 ± 12.5 years. After a mean follow-up of 14.1 ± 5.9 months (6–32 months), the number of patients with a mitral valve peak gradient >7.5 mm Hg, a mitral valve mean gradient >3 mm Hg, and a pulmonary arterial pressure (PAP) ≥25 mm Hg at rest were 50%, 40.6%, and 62.5%, respectively. 13 patients (40.6%) had incomplete treadmill exercise test. All hemodynamic parameters were higher at peak exercise compared with at rest levels (all P <.05). The PAP at rest and at peak exercise as well as peak transmitral gradient at peak exercise were higher in patients with incomplete exercise compared with complete exercise test (all P <.05). The PAP at rest (a sensitivity and a specificity of 84.6% and 52.6%, respectively; area under the curve [AUC] =.755) and at peak exercise (a sensitivity and a specificity of 100% and 47.4%, respectively; AUC =.755) discriminated incomplete exercise test. Conclusion: The RMA for degenerative MR was associated with a functional stenosis and the PAP at rest and at peak exercise discriminated low exercise capacity. © 2017, Wiley Periodicals, Inc.