Abstract
Clinical decision-making in symptomatic patients after mitral valve (MV) repair remains challenging as echocardiographic reference values are lacking. In native MV disease intervention is recommended for mean transmitral pressure gradient (TPG) >15 mmHg or systolic pulmonary artery pressure (SPAP) >60 mmHg at peak exercise. Insight into standard stress echo parameters after MV repair may therefore aid to clinical decision-making during follow-up. Stress echocardiography derived parameters in asymptomatic patients after successful MV repair differ from current guidelines for native valves. In 25 patients (NYHA I) after MV repair stress echocardiography was performed on a semi-supine bicycle. Doppler flow records and MV related hemodynamics at rest and peak were obtained. Linear regression analysis was performed for mean TPG and SPAP at peak, using predetermined variables and confounders. Mean TPG at rest (3.2 ± 1.4 mmHg) significantly increased at peak (15.0 ± 3.4 mmHg) but was always <25 mmHg. Mean SPAP at rest (21.4 ± 3.8 mmHg) significantly increased at peak (41.8 ± 8.9 mmHg) but was never >57 mmHg. Only the indexed MV ring diameter was inversely correlated to mean TPG at peak in a multivariable model. In contrast to current recommendations in native MV disease, our data indicate that the standard value for mean TPG during stress echocardiography in asymptomatic patients after successful MV repair was above the guideline threshold of 15 mmHg in >50%, but always <25 mmHg. For SPAP, patients never reached the guideline cutoff (60 mmHg). Long-term follow-up data are needed to provide insight in clinical consequences. Baseline stress echocardiography may indicate individual reference values to compare with during follow-up. https://clinicaltrials.gov/ct2/show/NCT02371863?term=chamuleau+AND+Mitral&rank=1.
Highlights
Mitral valve (MV) regurgitation is a common valve disease and associated with significant morbidity and mortality worldwide [1, 2]
In contrast to current recommendations in native MV disease, our data indicate that the standard value for mean transmitral pressure gradient (TPG) during stress echocardiography in asymptomatic patients after successful MV repair was above the guideline threshold of 15 mmHg in >50%, but always
The mean TPG measured by echocardiography within the first 5 days after repair was always
Summary
Mitral valve (MV) regurgitation is a common valve disease and associated with significant morbidity and mortality worldwide [1, 2]. High success rates and low mortality numbers are reported [15,16,17,18], recurrent or persistent complaints after isolated MV repair remain a clinical challenge, in particular when transthoracic echocardiography (TTE) parameters are within normal range at rest In this respect, exercise echo parameters may be helpful by complementing resting two-dimensional (2D) TTE in clinical practice [19,20,21,22]. The purpose of our study was to provide insight into standard stress echo derived parameters in asymptomatic patients after successful MV repair We hypothesize that these values differ from current guidelines for native valves, which may aid to clinical decision-making at follow-up. Hypothesis: Stress echocardiography derived parameters in asymptomatic patients after successful MV repair differ from current guidelines for native valves
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