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Banno J, Radwan Y, Patel R, Dandamudi S, McNamara M, Wolschleger K. Transient Severe Functional Mitral Valve Regurgitation: An Extremely Rare Cause of Recurrent Pulmonary Edema. JACC Case Rep 2023; 16:101884. [PMID: 37396322 PMCID: PMC10313490 DOI: 10.1016/j.jaccas.2023.101884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 04/26/2023] [Indexed: 07/04/2023]
Abstract
A 79-year-old woman presented with recurrent pulmonary edema. Extensive testing spanning 5 admissions showed only mild mitral regurgitation (MR). A transthoracic echocardiogram with the patient in the supine position and passive leg raise showed severe MR. This suggested transient severe MR. She underwent mitral valve replacement and had an uneventful postoperative course without recurrence of symptoms. (Level of Difficulty: Intermediate.).
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Affiliation(s)
- Joseph Banno
- Corewell Health West/Fred and Lena Meijer Heart Center, Grand Rapids, Michigan, USA
- Michigan State University, Grand Rapids, Michigan, USA
| | - Yasser Radwan
- Corewell Health West/Fred and Lena Meijer Heart Center, Grand Rapids, Michigan, USA
| | - Rima Patel
- Corewell Health West/Fred and Lena Meijer Heart Center, Grand Rapids, Michigan, USA
| | - Sanjay Dandamudi
- Corewell Health West/Fred and Lena Meijer Heart Center, Grand Rapids, Michigan, USA
- Michigan State University, Grand Rapids, Michigan, USA
| | - Michael McNamara
- Corewell Health West/Fred and Lena Meijer Heart Center, Grand Rapids, Michigan, USA
- Michigan State University, Grand Rapids, Michigan, USA
| | - Kevin Wolschleger
- Corewell Health West/Fred and Lena Meijer Heart Center, Grand Rapids, Michigan, USA
- Michigan State University, Grand Rapids, Michigan, USA
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Coisne A, Aghezzaf S, Galli E, Mouton S, Richardson M, Dubois D, Delsart P, Domanski O, Bauters C, Charton M, L'Official G, Modine T, Vincentelli A, Juthier F, Lancellotti P, Donal E, Montaigne D. Prognostic values of exercise echocardiography and cardiopulmonary exercise testing in patients with primary mitral regurgitation. Eur Heart J Cardiovasc Imaging 2021; 23:1552-1561. [PMID: 34751769 DOI: 10.1093/ehjci/jeab231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 10/19/2021] [Indexed: 11/12/2022] Open
Abstract
AIMS To compare the clinical significance of exercise echocardiography (ExE) and cardiopulmonary exercise testing (CPX) in patients with ≥moderate primary mitral regurgitation (MR) and discrepancy between symptoms and MR severity. METHODS AND RESULTS Patients consulting for ≥moderate discordant primary MR prospectively underwent low (25 W) ExE, peak ExE, and CPX within 2 months in Lille and Rennes University Hospital. Patients with Class I recommendation for surgical MR correction were excluded. Changes in MR severity, systolic pulmonary artery pressure (SPAP), left ventricular ejection fraction (LVEF), and tricuspid annular plane systolic excursion were evaluated during ExE. Patients were followed for major events (ME): cardiovascular death, acute heart failure, or mitral valve surgery. Among 128 patients included, 22 presented mild-to-moderate, 61 moderate-to-severe, and 45 severe MR. Unlike MR variation, SPAP and LVEF were successfully assessed during ExE in most patients. Forty-one patients (32%) displayed reduced aerobic capacity (peak VO2 < 80% of predicted value) with cardiac limitation in 28 (68%) and muscular or respiratory limitation in the 13 others (32%). ME occurred in 61 patients (47.7%) during a mean follow-up of 27 ± 21 months. Twenty-five Watts SPAP [hazard ratio (HR) (95% confidence interval, CI) = 1.03 (1.01-1.06), P = 0.003] and reduced aerobic capacity [HR (95% CI) = 1.74 (1.03-2.95), P = 0.04] were independently predictive of ME, even after adjustment for MR severity. The cut-off of 55 mmHg for 25 W SPAP showed the best accuracy to predict ME (area under the curve = 0.60, P = 0.05). CONCLUSION In patients with ≥moderate primary MR and discordant symptoms, 25 W exercise pulmonary hypertension, defined as an SPAP ≥55 mmHg, and poor aerobic capacity during CPX are independently associated with adverse events.
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Affiliation(s)
- Augustin Coisne
- University of Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1011 - EGID, F-59000 Lille, France
| | - Samy Aghezzaf
- University of Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1011 - EGID, F-59000 Lille, France
| | - Elena Galli
- University of Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, F-35000 Rennes, France
| | - Stéphanie Mouton
- University of Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1011 - EGID, F-59000 Lille, France
| | - Marjorie Richardson
- University of Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1011 - EGID, F-59000 Lille, France
| | - Denis Dubois
- University of Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1011 - EGID, F-59000 Lille, France
| | - Pascal Delsart
- University of Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1011 - EGID, F-59000 Lille, France
| | - Olivia Domanski
- University of Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1011 - EGID, F-59000 Lille, France
| | - Christophe Bauters
- University of Lille, Inserm, CHU Lille, Institut Pasteur, U1167, F-59000 Lille, France
| | - Marion Charton
- University of Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, F-35000 Rennes, France
| | - Guillaume L'Official
- University of Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, F-35000 Rennes, France
| | - Thomas Modine
- University of Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1011 - EGID, F-59000 Lille, France
| | - André Vincentelli
- University of Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1011 - EGID, F-59000 Lille, France
| | - Francis Juthier
- University of Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1011 - EGID, F-59000 Lille, France
| | - Patrizio Lancellotti
- Departments of Cardiology, University of Liège Hospital, GIGA Cardiovascular Sciences, Heart Valve Clinic, CHU Sart Tilman, 4000 Liège, Belgium.,Gruppo Villa Maria Care and Research, Maria Cecilia Hospital, Cotignola, and Anthea Hospital, 70100 Bari, Italy
| | - Erwan Donal
- University of Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, F-35000 Rennes, France
| | - David Montaigne
- University of Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1011 - EGID, F-59000 Lille, France
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