Abstract 15013: A Rise in Systolic Pulmonary Arterial Pressure at Low Level of Exercise Predicts Prognosis in Asymptomatic Patients With Organic Mitral Regurgitation -Results From the PROGRAM Study
Introduction: The optimal timing of mitral valve surgery in asymptomatic patients with chronic severe organic mitral regurgitation (MR) is controversial. Exercise-induced pulmonary arterial hypertension (systolic pulmonary arterial pressure [SPAP] > 60 mmHg) has been shown to predict cardiac events.
Hypothesis: The objective of this study was to examine the prognostic value of the increase in the SPAP during the early phase of the exercise test in asymptomatic organic MR.
Methods: A total of 133 patients (age=61±14 years; 53% men) with at least a moderate asymptomatic MR who were not candidate for surgery were prospectively recruited in the PROGRAM study from 2008 to 2016. Doppler-Echocardiography was performed at rest and during a semi-supine bicycle exercise using a stepwise protocol with 25 Watt increments. Peak VO2 was measured during a separate treadmill exercise. SPAP was determined at each stage of exercise by measuring the peak systolic gradient of tricuspid regurgitation. The change in SPAP (ΔSPAP) between rest and the different stages of exercise was measured. The primary study end-point was the composite of occurrence of mitral valve surgery, permanent atrial fibrillation, heart failure, hospitalization, or death.
Results: During a mean follow-up of 2.74 ± 1.6 years, there were 44 (39%) events. Twenty-two percent of patients had a marked increase in SPAP (ΔSPAP >15 mmHg) during the first stage of exercise (i.e. from 0 to 25 W). The 3-year event-free survival was lower in patients with a ΔSPAP >15 mmHg at low level of exercise than in those with ΔSPAP ≤15 mmHg (57.2±10% versus 76±24%, p=0.03). Univariable analysis showed that a ΔSPAP >15 mmHg was associated with increased risk of cardiac events (HR: 1.99, 95% CI 1.01-3.77, p=0.04). After adjustment for MR severity (ERO), LV forward ejection fraction, indexed left atrial volume, VO2 max, and peak exercise SPAP >60 mmHg, a ΔSPAP>15 mmHg during first stage of exercise was an independent predictor of cardiovascular events (HR: 4.95, p=0.004).
Conclusions: Asymptomatic patients with MR presenting a rise in SPAP at low level of exercise have increased risk of cardiac events. The increase in SPAP during early phase of exercise stress test may help to identify patients who may benefit from earlier intervention.
Author Disclosures: O. Toubal: None. H. Mahjoub: None. C. Thébault: None. C. Bélanger: None. N. Côté: None. M. Clavel: None. J. Magne: None. A. Dahou: None. K. O’Connor: None. J. Beaudouin: None. M. Bernier: None. F. Le Ven: None. P. Pibarot: None.
- © 2016 by American Heart Association, Inc.