DIASTOLIC DYSFUNCTION IS ONE OF THE DETERMINANTS OF FUNCTIONAL CAPACITY
IN PATIENTS WITH SEVERE MITRAL REGURGITATION AND NORMAL EJECTION FRACTION J.J. Pereira*, E.P.
Cabanag-Demerre, M. Lauer, J.D. Thomas, A.L. Klein, M.J. Garcia. The
Cleveland Clinic Foundation, Cleveland, OH, USA. Objectives: Transmitral early diastolic
filling (E wave) deceleration time (DT) is an important determinant of
prognosis in heart failure, but has been poorly studied in mitral regurgitation
(MR). We sought to ascertain whether diastolic dysfunction is a determinant of
functional capacity (FC) in patients with significant chronic MR and normal
left ventricular (LV) function. Methods: We identified 56 patients from our exercise echocardiography database
over 24 months, with significant (>= 3+) MR and
normal LV systolic function (ejection fraction >50%). Clinical and
echocardiography variables were analysed for each patient in relation to their
estimated FC in METs, which was adjusted for age and gender. Results: Functional capacity was poor, average or good in 22, 14 and 20
patients respectively. The key variables analysed are summarized below. Other
clinical and echocardiography variables analysed, were not statistically
significant. Variable Poor
Average Good P
Age
(years) 54±19 56±11 56±12 NS Gender
(male/female) 7/15 8/6 15/5 0.02 MR
severity (3+/ 3+-4+/ 4+) 13/5/4 8/5/1 5/5/10 0.04 E
wave velocity (cm/sec) 111±24 96±27 122±19 0.01 DT
(msec) 185±28 222±65 207±30 0.03 Left
atrial area (cm2 ) 28±10 29±9 25±5 NS LV
end diastolic diameter (cm) 5.4±0.7 5.3±0.7 5.6±0.7 NS LV
end systolic diameter (cm) 3.2±0.6 2.8±0.8 3.0±0.5 NS Fractional
shortening (%) 41±9 48±10 47±7 0.04 Pulmonary
artery systolic
pressure (mmHg) * 42±5 32±6 32±12 0.05 *Tricuspid regurgitation was
detected in only 22 patients. Conclusions: 1) Diastolic, as well as systolic function, gender
and pulmonary hypertension are determinants of FC. 2) Severity of MR is not a
determinant of FC. Prospective studies
are needed to better assess the significance of diastolic dysfunction in MR
patients.
