Exercise Right Ventricular‐Pulmonary Arterial Coupling and Functional Outcome in Patients Undergoing Surgery for Secondary Ischemic Mitral Regurgitation
Background The exercise assessment of the right ventricular‐pulmonary arterial (PA) coupling adds diagnostic and prognostic value in patients with heart failure. In patients with ischemic mitral regurgitation undergoing surgery, data on the exercise assessment of the right ventricular‐PA coupling ar...
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| Language: | English |
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Wiley
2025-04-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
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| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.124.037198 |
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| author | Carlo Fino Diego Bellavia Michele D'Alonzo Maurizio Merlo Vito D. Bruno Julien Magne Massimo Caputo Amedeo Terzi Michele Senni Samuele Bichi Caterina Simon Edoardo Sciatti Giovanni Marchetto Attilio Iacovoni Philippe Pibarot |
| author_facet | Carlo Fino Diego Bellavia Michele D'Alonzo Maurizio Merlo Vito D. Bruno Julien Magne Massimo Caputo Amedeo Terzi Michele Senni Samuele Bichi Caterina Simon Edoardo Sciatti Giovanni Marchetto Attilio Iacovoni Philippe Pibarot |
| author_sort | Carlo Fino |
| collection | DOAJ |
| description | Background The exercise assessment of the right ventricular‐pulmonary arterial (PA) coupling adds diagnostic and prognostic value in patients with heart failure. In patients with ischemic mitral regurgitation undergoing surgery, data on the exercise assessment of the right ventricular‐PA coupling are not available. Resting and exercise echocardiographic predictors of functional outcome in patients with ischemic mitral regurgitation were tested. Methods Six‐minute walking test and exercise echocarrdiogram performed at baseline, at 1 years, and at a median follow‐up of 6 years (interquartile range, 3.70; range, 4.5–8) on 50 patients (67±8 years; ejection fraction: 35±5%) undergoing valve replacement or repair. Linear mixed models were used to evaluate the predictive value of preoperative echocardiographic parameters on the longitudinal distribution of the 6‐minute walking test. Results Preoperative exercise tricuspid annular plane systolic excursion (TAPSE)/PA systolic pressure strongly correlated with the long‐term 6‐minute walking test (r=0.81, P<0.01). The receiver operating characteristic analysis found a preoperative exercise TAPSE/PA systolic pressure <0.34 predicted the lowest quartile of the 6‐minute walking test in the long term (sensitivity: 79%; specificity: 100%) as well as a composite outcome of heart failure and death from any cause (positive predictive value: 91.3%, negative predictive value: 100%). On multivariable analysis, TAPSE and TAPSE/PA systolic pressure were significantly associated with a better long‐term 6‐minute walking test. Conclusions A preoperative exercise TAPSE/PA systolic pressure <0.34 predicts a poor functional performance and a higher likelihood of clinical adverse events. In patients with ischemic mitral regurgitation the exercise right ventricular ‐PA coupling could improve risk stratification. Larger studies are needed. |
| format | Article |
| id | doaj-art-75acac69a7a948cbabbb4eba9bb262ae |
| institution | Kabale University |
| issn | 2047-9980 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | Wiley |
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| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj-art-75acac69a7a948cbabbb4eba9bb262ae2025-08-20T03:47:40ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802025-04-0114810.1161/JAHA.124.037198Exercise Right Ventricular‐Pulmonary Arterial Coupling and Functional Outcome in Patients Undergoing Surgery for Secondary Ischemic Mitral RegurgitationCarlo Fino0Diego Bellavia1Michele D'Alonzo2Maurizio Merlo3Vito D. Bruno4Julien Magne5Massimo Caputo6Amedeo Terzi7Michele Senni8Samuele Bichi9Caterina Simon10Edoardo Sciatti11Giovanni Marchetto12Attilio Iacovoni13Philippe Pibarot14Cardiovascular and Transplant Department Ospedale Papa Giovanni XXIII Bergamo ItalyDivision of Cardiovascular Diseases Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT) Palermo ItalyCardiac Surgery Department Henri‐Mondor University Hospital Creteil FranceCardiovascular and Transplant Department Ospedale Papa Giovanni XXIII Bergamo ItalyUniversity of Bristol Medical School – Translational Health Science Bristol UKService de Cardiologie CHU Limoges Limoges FranceUniversity of Bristol Medical School – Translational Health Science Bristol UKCardiovascular and Transplant Department Ospedale Papa Giovanni XXIII Bergamo ItalyCardiovascular and Transplant Department Ospedale Papa Giovanni XXIII Bergamo ItalyCardiovascular and Transplant Department Ospedale Papa Giovanni XXIII Bergamo ItalyCardiovascular and Transplant Department Ospedale Papa Giovanni XXIII Bergamo ItalyCardiovascular and Transplant Department Ospedale Papa Giovanni XXIII Bergamo ItalyFondazione IRCCS San Gerardo dei Tintori Monza ItalyCardiovascular and Transplant Department Ospedale Papa Giovanni XXIII Bergamo ItalyQuebec Heart and Lung Institute Quebec CanadaBackground The exercise assessment of the right ventricular‐pulmonary arterial (PA) coupling adds diagnostic and prognostic value in patients with heart failure. In patients with ischemic mitral regurgitation undergoing surgery, data on the exercise assessment of the right ventricular‐PA coupling are not available. Resting and exercise echocardiographic predictors of functional outcome in patients with ischemic mitral regurgitation were tested. Methods Six‐minute walking test and exercise echocarrdiogram performed at baseline, at 1 years, and at a median follow‐up of 6 years (interquartile range, 3.70; range, 4.5–8) on 50 patients (67±8 years; ejection fraction: 35±5%) undergoing valve replacement or repair. Linear mixed models were used to evaluate the predictive value of preoperative echocardiographic parameters on the longitudinal distribution of the 6‐minute walking test. Results Preoperative exercise tricuspid annular plane systolic excursion (TAPSE)/PA systolic pressure strongly correlated with the long‐term 6‐minute walking test (r=0.81, P<0.01). The receiver operating characteristic analysis found a preoperative exercise TAPSE/PA systolic pressure <0.34 predicted the lowest quartile of the 6‐minute walking test in the long term (sensitivity: 79%; specificity: 100%) as well as a composite outcome of heart failure and death from any cause (positive predictive value: 91.3%, negative predictive value: 100%). On multivariable analysis, TAPSE and TAPSE/PA systolic pressure were significantly associated with a better long‐term 6‐minute walking test. Conclusions A preoperative exercise TAPSE/PA systolic pressure <0.34 predicts a poor functional performance and a higher likelihood of clinical adverse events. In patients with ischemic mitral regurgitation the exercise right ventricular ‐PA coupling could improve risk stratification. Larger studies are needed.https://www.ahajournals.org/doi/10.1161/JAHA.124.0371986‐minute walking testexercise stress echocardiographyright ventricular – pulmonary artery couplingsecondary ischemic mitral regurgitation |
| spellingShingle | Carlo Fino Diego Bellavia Michele D'Alonzo Maurizio Merlo Vito D. Bruno Julien Magne Massimo Caputo Amedeo Terzi Michele Senni Samuele Bichi Caterina Simon Edoardo Sciatti Giovanni Marchetto Attilio Iacovoni Philippe Pibarot Exercise Right Ventricular‐Pulmonary Arterial Coupling and Functional Outcome in Patients Undergoing Surgery for Secondary Ischemic Mitral Regurgitation Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease 6‐minute walking test exercise stress echocardiography right ventricular – pulmonary artery coupling secondary ischemic mitral regurgitation |
| title | Exercise Right Ventricular‐Pulmonary Arterial Coupling and Functional Outcome in Patients Undergoing Surgery for Secondary Ischemic Mitral Regurgitation |
| title_full | Exercise Right Ventricular‐Pulmonary Arterial Coupling and Functional Outcome in Patients Undergoing Surgery for Secondary Ischemic Mitral Regurgitation |
| title_fullStr | Exercise Right Ventricular‐Pulmonary Arterial Coupling and Functional Outcome in Patients Undergoing Surgery for Secondary Ischemic Mitral Regurgitation |
| title_full_unstemmed | Exercise Right Ventricular‐Pulmonary Arterial Coupling and Functional Outcome in Patients Undergoing Surgery for Secondary Ischemic Mitral Regurgitation |
| title_short | Exercise Right Ventricular‐Pulmonary Arterial Coupling and Functional Outcome in Patients Undergoing Surgery for Secondary Ischemic Mitral Regurgitation |
| title_sort | exercise right ventricular pulmonary arterial coupling and functional outcome in patients undergoing surgery for secondary ischemic mitral regurgitation |
| topic | 6‐minute walking test exercise stress echocardiography right ventricular – pulmonary artery coupling secondary ischemic mitral regurgitation |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.124.037198 |
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