AIMS Restrictive mitral annuloplasty (RMA) can provide a durable solution for functional mitral regurgitation (MR), but might result in obstruction to antegrade mitral flow. Aim of this study was to assess the magnitude of change in mitral valve area (MVA) during exercise after RMA, to relate the change in MVA to left ventricular (LV) geometry and function, and to assess its haemodynamic and clinical impact. METHODS AND RESULTS Bicycle exercise echocardiography was performed in 32 patients after RMA. Echocardiographic data at rest and during exercise were compared with preoperative echocardiographic data. Clinical endpoints were collected following the study visit. MVA increased during exercise in 25 patients (1.6 ± 0.4 cm2 to 2.0 ± 0.6 cm2, P < 0.001), whereas MVA decreased in 7 patients (1.8 ± 0.5 cm2 to 1.5 ± 0.4 cm2, P = 0.020). Patients with an increased MVA showed a significant reduction in LV volumes at rest compared to preoperatively, and an increase in stroke volume and cardiac output (CO) during exercise. In patients with decreased MVA, LV reverse remodelling was absent and myocardial flow reserve limited. Patients with decreased exercise MVA had a higher increase in mean pulmonary artery pressure (PAP) with respect to CO and worse survival 36 months after the study visit (69±19% vs. 92±5%, P = 0.005). CONCLUSIONS Both increased and decreased MVA were observed during exercise echocardiography after RMA for functional MR. Change in MVA was related to the extent of LV geometrical and functional changes. A decreased MVA during exercise was associated with a higher increase in mean PAP with respect to CO, and worse survival.

中文翻译：

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限制性二尖瓣瓣环成形术后功能性二尖瓣反流的运动血流动力学。

AIMS限制性二尖瓣瓣环成形术（RMA）可以为功能性二尖瓣反流（MR）提供持久的解决方案，但可能会导致二尖瓣流顺行性阻塞。本研究的目的是评估RMA运动后二尖瓣面积（MVA）的变化幅度，将MVA的变化与左心室（LV）的几何形状和功能相关联，并评估其血流动力学和临床影响。方法和结果RMA后对32例患者进行了自行车运动超声心动图检查。将静止和运动过程中的超声心动图数据与术前超声心动图数据进行比较。在研究访问后收集临床终点。运动期间MVA升高25位患者（1.6±0.4 cm2至2.0±0.6 cm2，P <0.001），而MVA降低7位患者（1.8±0.5 cm2至1.5±0.4 cm2，P = 0.020）。与术前相比，MVA增加的患者在静息状态下的LV量显着减少，而运动时的卒中量和心输出量（CO）则增加。在MVA降低的患者中，不存在左室逆向重构，并且心肌血流储备受到限制。运动量减少的患者MVA相对于CO的平均肺动脉压（PAP）升高较高，并且在研究拜访后36个月生存率较差（69±19％对92±5％，P = 0.005）。结论在功能性MR的RMA运动性超声心动图检查期间，MVA升高和降低。MVA的变化与LV几何和功能变化的程度有关。运动期间MVA的降低与平均PAP相对于CO的升高以及生存期变差有关。