Article Text
Abstract
Objective Secondary mitral regurgitation (MR) demonstrates dynamic change during exercise. This prospective observational study aimed to compare exercise stress echocardiography (ESE) where handgrip exercise (handgrip-ESE) or semisupine ergometer exercise was performed (ergometer-ESE) for patients with secondary MR.
Methods Handgrip-ESE and symptom-limited ergometer-ESE were performed for 53 patients (median age (IQR): 68 (58–78) years; 70% male) on the same day. Baseline global longitudinal strain (GLS) was 9.2% (6.0%–14.0%) and MR volume was 20 (14–26) mL. All-cause death and cardiac hospitalisation were tracked for median 439 (101–507) days.
Results Handgrip-ESE induced slightly but significantly greater degrees of MR increase (median one grade increase; p<0.001) than ergometer-ESE, although the changes in other parameters, including GLS (+1.1% vs −0.6%, p<0.001), were significantly smaller. Correlations between the two examinations with respect to the changes in the echocardiographic parameters were weak. Kaplan-Meier analyses revealed poor improvement in GLS during ergometer-ESE, but not the change in MR, was associated with adverse events (p=0.0065). No echocardiographic change observed during handgrip-ESE was prognostic. After adjusting for a clinical risk score, GLS changes during ergometer-ESE remained significant in predicting the adverse events (HR 0.39, p=0.03) A subgroup analysis in patients with moderate or greater MR at baseline (n=27) showed the same results as in the entire cohort.
Conclusions The physiological and prognostic implications of handgrip-ESE and ergometer-ESE findings significantly differ in patients with left ventricular dysfunction and secondary MR. The type of exercise to be performed in ESE should be carefully selected.
- heart failure
- echocardiography
- mitral valve insufficiency
Data availability statement
Data are available upon reasonable request directly to the authors.
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Data availability statement
Data are available upon reasonable request directly to the authors.
Supplementary materials
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Footnotes
NK and MT are joint first authors.
Twitter @KagiyamaNobu
NK and MT contributed equally.
Collaborators Hikari Kaneko, Kaoru Sagisawa, Kumiko Ogasawara, Chikako Ikebuchi, Takuya Koyama, Rika Yoneyama, Hiromi Motobe.
Contributors NK—planning, data acquisition, statistical analysis, writing and all. MT—planning, data acquisition and writing. TY—data acquisition and critical reviewing. SA—data acquisition and critical reviewing. AH—data acquisition and critical reviewing. PPS—writing and critical reviewing. KY—planning, writing and critical reviewing.
Funding This work was partially supported by JSPS KAKENHI Grant-in-Aid for Research Activity Start-up (grant number: 20K22504).
Competing interests NK is affiliated with and receives salary from a department funded by Philips Healthcare; Asahi KASEI Corporation; Inter Reha Co and Toho Holdings Co based on collaborative research agreements. PPS is a consultant to HeartSciences, Ultromics and Kencor Health.
Provenance and peer review Not commissioned; externally peer reviewed.