Background: The aim of this article is to present a systematic review of publications regarding
the role of exercise echocardiography in the evaluation of functional mitral regurgitation.
Methods: The PubMed database was searched using the following combination of keywords:
“mitral” and “regurgitation” and “exercise” and “echocardiography”. Initially, a list of 152
articles published between 1977 and 2007 was retrieved. Following application of the exclusion
criteria, the list was shortened to 18 original scientific papers. Different groups of patients were
analyzed in these studies, but mainly patients with ischemic left ventricular systolic dysfunction
with at least mild mitral regurgitation were included. All participants underwent
echocardiography, which included resting examination and certain stress tests, i.e. exercise
tests using a cycloergometer or a treadmill as well as pharmacological stress. The main
evaluated echocardiographic parameters were regurgitant volume, effective regurgitant orifice
area (ERO), left ventricular geometry and function, and systolic pulmonary artery pressure.
Results: Exercise-induced changes in mitral regurgitation parameters were strongly associated
with the risk of pulmonary edema, mortality, exercise tolerance and the severity of ischemic
heart disease. The most important echocardiographic variable was an increase in ERO of
more than 13 mm2 during exercise.
Conclusions: Published scientific evidence demonstrates the significance of exercise
echocardiography in patients with functional mitral regurgitation in relation to its dynamic
character, the possibility of a considerable increase in the severity of even mild mitral
regurgitant jet with changing loading conditions and especially with increased left ventricular
afterload. (Cardiol J 2007; 14: 436-446
