Abstract 13645: Prognostic Value of Pulmonary Artery Pressure Assessment during Ankle Flexing Exercise in Patients with Heart Failure Showing Functional Mitral Regurgitation
Introduction: Presence of functional mitral regurgitation (MR) is a useful marker of increased mortality in patients with heart failure. Because functional MR can change dynamically in response to loading conditions, several manuscripts have reported advantages of stress echocardiography for assessment of dynamic component of functional MR.
Recently, we have developed a new stress echocardiography using ankle-flexing exercise, namely ankle flexing stress echocardiography (AFSE). AFSE has a unique feature that venous return rapidly increases without remarkable blood pressure augmentation.
Hypothesis: We hypothesized that rapid increase of venous return could directly alter pulmonary arterial pressure and elevated pulmonary artery pressure might be associated with poor prognosis. The aim of this study was to evaluate whether the increase of pulmonary artery pressure during AFSE was associated with future cardiac events in patients with heart failure.
Methods: Between August 2012 and May 2014, 52 consecutive patients with chronic heart failure showing at least mild functional MR were underwent AFSE. All of them were stable since at least 3 months. Prospective follow-up for future cardiac events was obtained in all patients. Adverse cardiac events were defined as cardiac death, ventricular tachycardia, recurrent heart failure required hospitalization, and newly onset of atrial fibrillation/flutter. After routine echocardiography study, AFSE was performed at spine position. Symptom-limited ankle flexing stress was loaded against 6.3Kgw/foot at the speed of 1 time/sec. We defined 10 mmHg increases in trans-tricuspid pressure gradient as an elevated pulmonary artery pressure.
Results: No adverse event was recorded during AFSE. Severe functional MR (ERO≧ 20 mm2) at rest was found in 23 (45%) of patients. Elevated pulmonary artery pressure was found in 28 (31%) patients. During follow-up periods (average 20±10 month), 22 (43%) of patients suffered adverse cardiac events. Kaplan-Meier analysis showed that patients with the elevated pulmonary artery pressure were associated with poor prognosis (p<0.01).
Conclusions: patients with chronic heart failure, increase of pulmonary artery pressure during AFSE is associated with poor outcomes.
Author Disclosures: A. Tanaka: None. Y. Omae: None. M. Takenaka: None.
- © 2014 by American Heart Association, Inc.