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Exercise-induced mitral regurgitation and right ventricle to pulmonary circulation uncoupling across the heart failure phenotypes

Bandera, F; Barletta, M; Fontana, M; Boveri, S; Ghizzardi, G; Alfonzetti, E; Ambrogi, F; (2021) Exercise-induced mitral regurgitation and right ventricle to pulmonary circulation uncoupling across the heart failure phenotypes. American Journal of Physiology - Heart and Circulatory Physiology , 320 (2) H642-H653. 10.1152/ajpheart.00507.2020. Green open access

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Abstract

Exercise-induced mitral regurgitation (Ex-MR) is one of the mechanisms that contribute to reduced functional capacity in heart failure (HF). Its prevalence is not well defined across different HF subtypes. The aim of the present study was to describe functional phenotypes and cardiac response to exercise in HFrEF, HFmrEF, and HFpEF, according to Ex-MR prevalence. A total of 218 patients with HF [146 men, 68 (59–78) yr], 137 HFrEF, 41 HFmrEF, 40 HFpEF, and 23 controls were tested with cardiopulmonary exercise test combined with exercise echocardiography. Ex-MR was defined as development of at least moderate (≥2+/4+) regurgitation during exercise. Ex-MR was highly prevalent in the overall population (52%) although differed in the subgroups as follows: 82/137 (60%) in HFrEF, 17/41 (41%) in HFmrEF, and 14/40 (35%) in HFpEF (P < 0.05). Ex-MR was associated with a high rate of ventilation (VE) to carbon dioxide production (VCO2) in all HF subtypes [31.2 (26.6–35.6) vs. 33.4 (29.6–40.5), P = 0.004; 28.1 (24.5–31.9) vs. 34.4 (28.2–36.7), P = 0.01; 28.8 (26.6–32.4) vs. 32.2 (29.2–36.7), P = 0.01] and with lower peak VO2 in HFrEF and HFmrEF. Exercise right ventricle to pulmonary circulation (RV-PC) uncoupling was observed in HFrEF and HFpEF patients with Ex-MR [peak TAPSE/SPAP: HFrEF 0.40 (0.30–0.57) vs. 0.29 (0.23–0.39), P = 0.006; HFpEF 0.44 (0.28–0.62) vs. 0.31 (0.27–0.33), P = 0.05]. HFpEF with Ex-MR showed a distinct phenotype characterized by better chronotropic reserve and peripheral O2 extraction.

Type: Article
Title: Exercise-induced mitral regurgitation and right ventricle to pulmonary circulation uncoupling across the heart failure phenotypes
Open access status: An open access version is available from UCL Discovery
DOI: 10.1152/ajpheart.00507.2020
Publisher version: http://dx.doi.org/10.1152/ajpheart.00507.2020
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: echocardiography, HFpEF, mitral regurgitation, pulmonary hypertension, right ventricle, PRESERVED EJECTION FRACTION, CONTRACTILE FUNCTION, CLINICAL PHENOTYPES, ECHOCARDIOGRAPHY, DYSFUNCTION, INSIGHTS, RESERVE
UCL classification: UCL
UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine > Inflammation
URI: https://discovery.ucl.ac.uk/id/eprint/10130999
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