Abstract
Background Current guidelines recommend mitral valve surgery for asymptomatic patients with severe organic mitral regurgitation (OMR) and preserved left ventricular systolic function when exercise pulmonary hypertension (PHT) is present. The aim of this study was to identify the determinants of exercise PHT and the impact on symptom-free survival. Methods and results Comprehensive resting and exercise transthoracic echocardiography were performed in 78 consecutive asymptomatic patients (61 ± 13 years, 56% males) with moderate OMR. Resting and exercise PHT were defined as a systolic pulmonary arterial pressure (SPAP) >50 mmHg and >60 mmHg, respectively. Exercise PHT was more frequent than resting PHT (48% vs. 15%, p 56 mmHg predicted symptoms with good specificity (73%) and sensitivity (82%). Conclusions Exercise PHT is frequent in patients with asymptomatic OMR. Exercise MR severity is a strong independent predictor of both exercise SPAP and exercise PHT. Exercise PHT is associated with markedly low 2-year symptom-free survival emphasizing the use of exercise stress echocardiography.
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