Allison, Thomas

Bellamy, Michael

Capps, Maryann

Enriquez-Sarano, Maurice

Irvin, Suzanne

Johnson, Bruce

Messika-Zeitoun, David

Nkomo, Vuyisile

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442A ABSTRACTS - Valvular Heart Disease JACC March 3, 2004
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868-6 Functional Capacity Assessment by Cardiopulmonary 
Exercise Testing in Organic Mitral Regurgitation: A 
Prospective Quantitative Study
David Messika-Zeitoun, Michael Bellamy, Bruce Johnson, Vuyisile Nkomo, Suzanne 
Irvin, Maryann Capps, Thomas Allison, Maurice Enriquez-Sarano, Mayo Clinic, 
Rochester, MN
Background: Management of patients with organic mitral regurgitation (MR) relies on
limitations of functional capacity (FC) assessed by symptoms but these are subjective.
Cardiopulmonary exercise testing (CPET) can objectively assess FC but is inconsistently
used as the information obtained has not been fully analyzed. Hence, the determinants of
the variable FC of patients with organic MR are poorly understood.
Methods: In 101 patients with organic non rheumatic MR we prospectively and quantita-
tively assessed MR severity (effective regurgitant orifice, ERO), left ventricular (LV) vol-
umes, mass and diastolic function by Doppler-echo and FC (peak oxygen consumption,
VO2) by CPET.
Results: Determinants of FC: Mean ERO was 36±14 mm2 (60% severe MR). Peak VO2
was 26±6 mL/kg/min (97±17% of age and gender predicted value). However FC varied
widely (53 to 145 % of predicted). Independent determinants of low peak VO2 were
degree of MR (ERO, p=0.006), hemodynamic (low forward stroke, p=0.0003), LV diastolic
(high LV mass/volume ratio, p=0.003; high E/E' ratio by Doppler Tissue Imaging,
p=0.006) and ventilatory alterations (high VE/VCO2 slope, p=0.04). Relationship
between symptoms and FC: Overall FC was reduced in 17% (peak VO2 <84% pre-
dicted). Compared to patients in NYHA class I (n=72) or II (n=22), patients in class III
(n=7) had more severe hemodynamic alterations and most of them (71%) had a reduced
FC. In contrast, patients in class I and II had undistinguishable hemodynamics and had
similar FC (99±15% vs. 95±15 % of predicted, p=0.25). Importantly, FC was frequently
and similarly reduced in both classes (13 and 14%) particularly in patients with severe
MR (18 and 21%).
Conclusion: In patients with organic MR, FC quantitatively measured varies widely
between patients. Although higher degrees of MR are associated with lower peak VO2,
LV diastolic and ventilatory dysfunction are major predictors of reduced FC. Patients in
NYHA class I and II are undistinguishable and in those patients CPET frequently reveals
functional limitations not detected clinically. Therefore, CPET is an important tool for the
detection and comprehension of reduced FC and hence for the management of patients
with organic MR.


868-6 Functional capacity assessment by cardiopulmonary exercise testing in organic mitral regurgitation: A prospective quantitative study 

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868-6 Functional capacity assessment by cardiopulmonary exercise testing in organic mitral regurgitation: A prospective quantitative study

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