AUTHOR=Jansen Rosemarijn , Urgel Kim , Cramer Maarten J. , van Aarnhem Egidius E. H. L. , Zwetsloot Peter P. M. , Doevendans Pieter A. , Kluin Jolanda , Chamuleau Steven A. J. 

TITLE=Reference Values for Physical Stress Echocardiography in Asymptomatic Patients after Mitral Valve Repair

JOURNAL=Frontiers in Surgery

VOLUME=Volume 5 - 2018

YEAR=2018

URL=https://www.frontiersin.org/journals/surgery/articles/10.3389/fsurg.2018.00006

DOI=10.3389/fsurg.2018.00006

ISSN=2296-875X

ABSTRACT=Background
Clinical decision making in symptomatic patients after mitral valve (MV) repair remains challenging as echocardiographic reference values are lacking. In native MV disease intervention is recommended for mean transmitral pressure gradient (TPG) >15mmHg or systolic pulmonary artery pressure (SPAP) >60mmHg at peak exercise. Insight into standard stress echo parameters after MV repair may therefore aid to clinical decision making during follow-up.

Hypothesis
Stress echocardiography derived parameters in asymptomatic patients after successful MV repair differ from current guidelines for native valves. 

Material and Methods
In 25 patients (NYHA I) after MV repair stress echocardiography was performed on a semi-supine bicycle. Doppler flow records and MV related hemodynamics at rest and peak were obtained. Linear regression analysis was performed for mean TPG and SPAP at peak, using pre-determined variables and confounders.

Results
Mean TPG at rest (3.2±1.4mmHg) significantly increased at peak (15.0±3.4mmHg), but was always <25mmHg. Mean SPAP at rest (21.4±3.8mmHg) significantly increased at peak (41.8±8.9mmHg), but was never >57mmHg. Only the indexed MV ring diameter was inversely correlated to mean TPG at peak in a multivariable model.

Conclusion
In contrast to current recommendations in native MV disease, our data indicate that the standard value for mean TPG during stress echocardiography in asymptomatic patients after successful MV repair was above the guideline threshold of 15mmHg in >50%, but always <25mmHg. For SPAP, patients never reached the guideline cut-off (60mmHg). Long-term follow-up data is needed to provide insight in clinical consequences. Baseline stress echocardiography may indicate individual reference values to compare with during follow-up.

URL of online clinical trial registration:
https://clinicaltrials.gov/ct2/show/NCT02371863?term=chamuleau+AND+Mitral&rank=1