P720Treadmill exercise echocardiography in patients undergoing mitral valve repair with mitral annuloplasty ring for ischemic mitral regurgitation

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Purpose: No data are available on the hemodynamic behaviour of repaired mitral valves during treadmill exercise. Our aim was to assess the association between mitral valve area (MVA), transmitral gradient and pulmonary artery pressure at rest and during treadmill exercise in patients with a history of mitral valve repair (MVR) for ischemic mitral regurgitation.Methods: We prospectively evaluated 44 patients (mean age 69.3 ± 8.9 years, 30 males) with a history of coronary artery disease and MVR with annuloplasty ring (with concomitant coronary artery bypass grafting in 34 patients) who underwent treadmill exercise echocardiography a mean of 2.35 ± 1.04 years after surgery. A modified Bruce protocol was employed in all cases. Left ventricular ejection fraction (LVEF), mean transmitral gradient (MTMG) and systolic pulmonary artery pressure (SPAP) were assessed at rest and at peak exercise with the patient still running on the treadmill.Results: At rest, LVEF was 45.7 ± 12.6%, MVA was 2.5 ± 0.66 cm2, MTMG was 3.93 ± 1.52 mmHg and SPAP was 38.1 ± 10.1 mmHg. Mean exercise workload was 5.8 ± 2.7 METs. At peak exercise, LVEF increased to 50.0 ± 14.7%, MTMG to 9.68 ± 4.71 mmHg, and SPAP to 56.2 ± 13.6 mmHg. A total of 17 patients (38.6%) developed a peak MTMG >10 mmHg, and 15 patients (34.1%) had a peak SPAP >60 mmHg. MVA at rest correlated with the increase in SPAP with exercise (r = -0.435, p = 0.01). MTMG at peak exercise (but not the value obtained at rest) correlated with peak SPAP (r = 0.47, p = 0.003) and with the increase in SPAP (r = 0.649, p <0.001).Conclusion: Functional mitral stenosis is a common problem in patients undergoing MVR for ischemic mitral regurgitation. MVA at rest and MTMG at peak exercise correlate with the increase in SPAP during exercise.

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