Cardiac remodelling and haemodynamic characteristics in primary mitral valve regurgitation

Rine Bakkestrøm, Ann Banke, Redi Pecini, Akhmadjon Irmukhamedov, Søren Kristian Nielsen, Mads J. Andersen, Barry A Borlaug, Jacob Eifer Moller

Research output: Contribution to journalArticle

Abstract

Objective: To assess the association between cardiac morphology and function assessed with cardiac MRI (CMRI) and haemodynamics at rest and during exercise in patients with primary mitral regurgitation (MR). Methods: In an observational study, subjects with significant primary MR (N = 46) with effective regurgitant orifice ≥ 0.30 cm2 and left ventricular (LV) ejection fraction > 60% were examined with right heart catheterisation during rest and exercise and CMRI at rest. End-diastolic pressure volume relationship (EDPVR) was assessed using a single beat method using pulmonary capillary wedge pressure (PCWP) and end-diastolic volume. Patients were divided according to normal PCWP at rest (> 12 mm Hg) and with exercise (> 28 mm Hg). Results: Resting regurgitant volume correlated positively with resting PCWP, (r = 0.42, p = 0.002). However, with exercise no association between PCWP and regurgitant volume was seen (r = 0.09, p = 0.55). At rest left atrial (LA) maximal, minimal and volume index at atrial contraction correlated positively with PCWP (r = 0.60; r = 0.55; r = 0.58, all p < 0.001); in contrast none of these correlated with exercise PCWP (all p > 0.2). EDPVR in patients with high PCWP at rest was shifted towards higher volumes for the same pressures. The opposite was seen for patients with high PCWP during exercise where estimated volumes were smaller for the same pressure than patients with normal exercise PCWP. Conclusion: In patients with significant MR the degree of regurgitation and LA dilatation is associated with resting PCWP. However, with exercise this association disappears. Estimation of EDPVR suggests lower LV compliance in patients where PCWP is increased with exercise.

Original languageEnglish (US)
Article numbere000919
JournalOpen Heart
Volume5
Issue number2
DOIs
StatePublished - Dec 1 2018

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Pulmonary Wedge Pressure
Mitral Valve Insufficiency
Hemodynamics
Exercise
Blood Pressure
Pressure
Cardiac Catheterization
Patient Compliance
Stroke Volume
Observational Studies
Dilatation

Keywords

  • haemodynamics
  • mitral regurgitation
  • MRI

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Bakkestrøm, R., Banke, A., Pecini, R., Irmukhamedov, A., Nielsen, S. K., Andersen, M. J., ... Moller, J. E. (2018). Cardiac remodelling and haemodynamic characteristics in primary mitral valve regurgitation. Open Heart, 5(2), [e000919]. https://doi.org/10.1136/openhrt-2018-000919

Cardiac remodelling and haemodynamic characteristics in primary mitral valve regurgitation. / Bakkestrøm, Rine; Banke, Ann; Pecini, Redi; Irmukhamedov, Akhmadjon; Nielsen, Søren Kristian; Andersen, Mads J.; Borlaug, Barry A; Moller, Jacob Eifer.

In: Open Heart, Vol. 5, No. 2, e000919, 01.12.2018.

Research output: Contribution to journalArticle

Bakkestrøm, R, Banke, A, Pecini, R, Irmukhamedov, A, Nielsen, SK, Andersen, MJ, Borlaug, BA & Moller, JE 2018, 'Cardiac remodelling and haemodynamic characteristics in primary mitral valve regurgitation', Open Heart, vol. 5, no. 2, e000919. https://doi.org/10.1136/openhrt-2018-000919
Bakkestrøm R, Banke A, Pecini R, Irmukhamedov A, Nielsen SK, Andersen MJ et al. Cardiac remodelling and haemodynamic characteristics in primary mitral valve regurgitation. Open Heart. 2018 Dec 1;5(2). e000919. https://doi.org/10.1136/openhrt-2018-000919
Bakkestrøm, Rine ; Banke, Ann ; Pecini, Redi ; Irmukhamedov, Akhmadjon ; Nielsen, Søren Kristian ; Andersen, Mads J. ; Borlaug, Barry A ; Moller, Jacob Eifer. / Cardiac remodelling and haemodynamic characteristics in primary mitral valve regurgitation. In: Open Heart. 2018 ; Vol. 5, No. 2.
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AU - Nielsen, Søren Kristian

AU - Andersen, Mads J.

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AB - Objective: To assess the association between cardiac morphology and function assessed with cardiac MRI (CMRI) and haemodynamics at rest and during exercise in patients with primary mitral regurgitation (MR). Methods: In an observational study, subjects with significant primary MR (N = 46) with effective regurgitant orifice ≥ 0.30 cm2 and left ventricular (LV) ejection fraction > 60% were examined with right heart catheterisation during rest and exercise and CMRI at rest. End-diastolic pressure volume relationship (EDPVR) was assessed using a single beat method using pulmonary capillary wedge pressure (PCWP) and end-diastolic volume. Patients were divided according to normal PCWP at rest (> 12 mm Hg) and with exercise (> 28 mm Hg). Results: Resting regurgitant volume correlated positively with resting PCWP, (r = 0.42, p = 0.002). However, with exercise no association between PCWP and regurgitant volume was seen (r = 0.09, p = 0.55). At rest left atrial (LA) maximal, minimal and volume index at atrial contraction correlated positively with PCWP (r = 0.60; r = 0.55; r = 0.58, all p < 0.001); in contrast none of these correlated with exercise PCWP (all p > 0.2). EDPVR in patients with high PCWP at rest was shifted towards higher volumes for the same pressures. The opposite was seen for patients with high PCWP during exercise where estimated volumes were smaller for the same pressure than patients with normal exercise PCWP. Conclusion: In patients with significant MR the degree of regurgitation and LA dilatation is associated with resting PCWP. However, with exercise this association disappears. Estimation of EDPVR suggests lower LV compliance in patients where PCWP is increased with exercise.

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