Abstract
Mitral regurgitation (MR) is the second most common valvular disease in western countries after aortic stenosis. Optimal management of patients with MR depends on the etiology of the regurgitation and is based predominantly on left ventricular function and functional status. Recent outcome studies report high risk subsets of asymptomatic patients with MR, and practice guidelines underscore the importance of a well-established estimation of exercise tolerance and recommend exercise testing to objectively assess functional status and hemodynamic factors.
Highlights
Mitral regurgitation (MR) is the second most common valve disease in western countries, after aortic stenosis, representing 32% of single native left-sided valve disease in a recent European survey [1]
Exercise echocardiography plays an important role in the evaluation and management of chronic mitral regurgitation
It can assist in the evaluation of symptoms, more fully assess the mechanism and severity of regurgitation, determine functional capacity, and assess contractile reserve to help optimize the timing of surgical intervention
Summary
Mitral regurgitation (MR) is the second most common valve disease in western countries, after aortic stenosis, representing 32% of single native left-sided valve disease in a recent European survey [1]. Secondary MR results from ischemic or myopathic changes to the left ventricle leading to incomplete closure of the mitral leaflets. In the latter conditions, leaflet morphology is relatively normal. The hemodynamic response to exercise in MR depends on the change in the severity of the regurgitant lesion and the ability of the left ventricle to meet increases in demands on workload. These two factors interact in complex ways. Risk stratification using exercise echocardiography, especially in asymptomatic patients, becomes important in accurate quantification and characterization of the etiology of MR, and in guiding therapy
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