Exercise tests during cardiac catheterisation in patients with mitral regurgitation (author's transl)

Abstract

Left-heart catheterisation with angiocardiography and right-heart catheterisation during exercise were performed in ten patients with pure chronic mitral regurgitation. Those patients who at rest had large normal haemodynamic parameters had a rise in pulmonary wedge pressure on exercise from 13.1 +/- 4.8 to 26.0 +/- 9.1 mm Hg (P less than 0.001), as well as subsequently an exercise-induced pulmonary hypertension with a rise in pulmonary arterial mean pressure from 20.9 +/- 8.9 to 36.5 +/- 10.3 mm Hg (P less than 0.001). In addition, there occurred abnormalities of right ventricular function in four patients during exercise, with a rise in right atrial mean pressure above 10 mm Hg. On the other hand, in 12 patients with pure mitral stenosis and higher pressures in the pulmonary artery on exercise (43.9 +/- 10.2 mm Hg) (P less than 0.1), there was no abnormal rise in right atrial pressure. In patients with mitral regurgitation associated with abnormal right ventricular function during exercise, left ventricular function at rest was impaired (ejection fraction under 51%). There was a reciprocal correlation (r = -0.86) between the left ventricular ejection fraction at rest and the level of pulmonary artery pressure on exercise. Exercise-induced pulmonary hypertension in chronic mitral regurgitation with largely normal pressure values at rest is thus less the result of volume overload of the pulmonary circulation than an expression of impaired left ventricular pumping action. Abnormal right ventricular function which occurs on exercise is not a secondary consequence of pulmonary hypertension but goes parallel with abnormal function of the left ventricle.