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A Simplified Stepwise Approach to Echo Guidance during Percutaneous Mitral Valve Repair
Published on: October 16, 2021
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Exercise behavior of degenerative mitral stenosis.
Benjamin Horn1, Kevin Bryan Lo1, Shantanu P Sengupta2
1Department of Internal Medicine, Einstein Medical Center, Philadelphia, PA, USA.
The International Journal of Cardiovascular Imaging
|May 28, 2020
Summary
Mitral annular calcification (MAC) causes significant mitral valve gradients and pulmonary pressure increases during exercise. This condition may be an under-recognized cause of exercise intolerance and dyspnea in elderly patients.
Area of Science:
- Cardiology
- Echocardiography
- Valvular Heart Disease
Background:
- Mitral annular calcification (MAC) is common in the elderly and those with chronic kidney disease.
- MAC can lead to a transvalvular gradient, but its impact on exercise limitation is not well understood.
- Rheumatic mitral stenosis is well-studied, but MAC-related mitral stenosis requires further investigation.
Purpose of the Study:
- To determine if exercise limitation in severe MAC is due to valvular obstruction or comorbidities.
- To compare exercise hemodynamics in patients with severe MAC to a matched control group.
- To investigate the relationship between mitral valve gradients and pulmonary artery pressure during exercise in MAC.
Main Methods:
- 20 patients with severe MAC underwent supine bicycle exercise.
- Doppler and echocardiographic parameters were measured at rest and during exercise.
- Patients were compared 1:1 to age-, sex-, and LV wall thickness-matched controls.
Main Results:
- MAC patients had higher baseline and exercise mitral valve gradients (MVG) and left atrial volumes.
- Exercise led to significant increases in MVG and pulmonary artery systolic pressure in MAC patients.
- A correlation was observed between increased MVG and increased pulmonary artery systolic pressure during exercise.
Conclusions:
- Severe MAC with a transvalvular gradient causes substantial increases in MVG and pulmonary pressure during exercise.
- MAC may be an under-recognized cause of dyspnea and exercise intolerance, particularly in older individuals.
- Further research is needed to fully understand the pathophysiology and management of MAC-related mitral stenosis.
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