Article Text
Abstract
Objective To assess the association between cardiac morphology and function assessed with cardiac MRI (CMRI) and haemodynamics at rest and during exercise in patients with primary mitral regurgitation (MR).
Methods In an observational study, subjects with significant primary MR (N = 46) with effective regurgitant orifice ≥ 0.30 cm2 and left ventricular (LV) ejection fraction > 60% were examined with right heart catheterisation during rest and exercise and CMRI at rest. End-diastolic pressure volume relationship (EDPVR) was assessed using a single beat method using pulmonary capillary wedge pressure (PCWP) and end-diastolic volume. Patients were divided according to normal PCWP at rest (> 12 mm Hg) and with exercise (> 28 mm Hg). Results: Resting regurgitant volume correlated positively with resting PCWP, (r = 0.42, p = 0.002). However, with exercise no association between PCWP and regurgitant volume was seen (r = 0.09, p = 0.55). At rest left atrial (LA) maximal, minimal and volume index at atrial contraction correlated positively with PCWP (r = 0.60; r = 0.55; r = 0.58, all p < 0.001); in contrast none of these correlated with exercise PCWP (all p > 0.2). EDPVR in patients with high PCWP at rest was shifted towards higher volumes for the same pressures. The opposite was seen for patients with high PCWP during exercise where estimated volumes were smaller for the same pressure than patients with normal exercise PCWP.
Conclusion In patients with significant MR the degree of regurgitation and LA dilatation is associated with resting PCWP. However, with exercise this association disappears. Estimation of EDPVR suggests lower LV compliance in patients where PCWP is increased with exercise.
Clinical trial registration URL: https://clinicaltrials.gov/ct2/show/NCT02961647?term=HEMI&rank=1. ID: NCT02961647
- mitral regurgitation
- MRI
- haemodynamics
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Footnotes
Contributors Conception or design of the work: RB, JEM, BAB, MJA. Data collection: RB, AB, RP. Data analysis and interpretation: all authors. Drafting the article: JEM. Critical revision of the article: all authors. Final approval of the version to be published: all authors.
Funding The Danish Heart Foundation, Copenhagen; Region of Southern Denmark; University of Southern Denmark, Odense; The Consultants Council of research Foundation, Odense; and Werner Richter and Wife Foundation, Gentofte, Denmark.
Competing interests None declared.
Patient consent for publication Not required.
Ethics approval Ethical committee for Region of Southern Denmark (ID S-20140127).
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement No additional data are available.