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Impact of changes in myocardial velocity assessed by tissue Doppler imaging during exercise on dynamic mitral regurgitation in patients with nonischemic cardiomyopathy.

Kang, SJ; Lim, HS; Hwang, J; Choi, JH; Seo, KW; Choi, BJ; Choi, SY; Hwang, GS; Yoon, MH; Shin, JH; Tahk, SJ
Echocardiography (Mount Kisco, N.Y.), 25(4):394-400, 2008
Journal Title
Echocardiography (Mount Kisco, N.Y.)
BACKGROUND: We evaluated the myocardial contractile reserve related to exercise-induced changes in functional mitral regurgitation (MR) by tissue Doppler imaging (TDI).

METHODS: Supine bicycle exercise was performed in 35 patients with nonischemic cardiomyopathy (age 51 +/- 12 years; EF < 40%) and resting, and peak exercise 2D echocardiographic parameters, and TDI data were obtained. V(avg) was defined as the average of peak systolic velocities of six basal LV segments by TDI. Myocardial contractile reserve, which was calculated by [peak exercise V(avg)- baseline V(avg)], was represented as DeltaV(avg). Dyssynchrony index was derived from the standard deviation of the time to the peak systolic velocity of 12 LV segments.

RESULTS: During exercise (9.7 +/- 2.4 minutes), the mean V(avg) increased from 4.0 +/- 0.8 cm/s to 5.5 +/- 1.0 cm/s. The effective regurgitant orifice area (ERO) and the ratio of MR jet area to the left atrial area (JLA%) were 1.9 +/- 2.9 mm(2) and 12 +/- 12%, respectively. During exercise, ERO and JLA% significantly increased to 6.2 +/- 6.4 mm(2) and 21 +/- 13% (P < 0.05), respectively, with individually variable changes. Tenting area was found to be an independent factor that showed a relationship with the baseline severity of MR (r = 0.561, P < 0.001). Dyssynchrony index and DeltaV(avg) were found to correlate with both maximal MR severity at peak exercise and changes in MR during exercise. By multivariate analysis, DeltaV(avg) was found to be an independent determinant of exercise-induced changes in ERO (DeltaERO; r =-0.707, P< 0.001) and changes in JLA% (DeltaJLA%; r =-0.663, P< 0.001).

CONCLUSION: In patients with nonischemic cardiomyopathy, impaired contractile reserve assessed by TDI velocity data may be an independent determinant affecting exercise-induced changes in dynamic MR.
MeSH terms
Cardiomyopathies/complications*Cardiomyopathies/physiopathologyCardiomyopathies/ultrasonographyEchocardiography, Doppler/methods*Exercise/physiology*Exercise Test/methods*FemaleFollow-Up StudiesHumansMaleMiddle AgedMitral Valve Insufficiency/complicationsMitral Valve Insufficiency/physiopathology*Mitral Valve Insufficiency/ultrasonographyMyocardial Contraction/physiology*PrognosisProspective StudiesSeverity of Illness Index
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Journal Papers > School of Medicine / Graduate School of Medicine > Cardiology
AJOU Authors
강, 수진임, 홍석황, 정원최, 병주최, 소연황, 교승윤, 명호신, 준한탁, 승제
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