%0 Journal Article %T Exercise capacity in asymptomatic patients with significant primary mitral regurgitation: independent effect of global longitudinal left ventricular strain %A Mentias, Amgad %A Alashi, Alaa %A Naji, Peyman %A Gillinov, A. Marc %A Rodriguez, L. Leonardo %A Mihaljevic, Tomislav %A Suri, Rakesh M. %A Grimm, Richard A. %A Svensson, Lars G. %A Griffin, Brian P. %A Desai, Milind Y. %J Cardiovascular Diagnosis and Therapy %D 2018 %B 2018 %9 %! Exercise capacity in asymptomatic patients with significant primary mitral regurgitation: independent effect of global longitudinal left ventricular strain %K %X Background: Despite preserved left ventricular ejection fraction (LVEF), patients with significant primary mitral regurgitation (MR) often have reduced exercise capacity. In asymptomatic patients with ≥3+ primary MR undergoing rest-stress echocardiography (RSE), we sought to evaluate the incremental impact of left ventricular global longitudinal strain (LV-GLS) on exercise capacity. Methods: A total of 660 asymptomatic patients with ≥3+ primary MR, non-dilated LV and LVEF ≥60% (mean age, 57±14 years, 66% men, body mass index or BMI 25±4 kg/m 2 ) who underwent RSE at our center between 2001 and 2013 were included. Standard RSE data were obtained. Average resting LV-GLS was measured using Velocity Vector Imaging. Results: Mean mitral effective regurgitant orifice, resting right ventricular systolic pressure (RVSP) and LV-GLS were 0.45±0.2 cm 2 , 31±12 mmHg and −21.7%±2%, respectively; 28% had flail mitral leaflet. Mean metabolic equivalents (METs) and post-stress RVSP were 9.9±3, and 46±17 mmHg; 28% achieved <100% age-gender predicted METs. No patient had ischemia or significant arrhythmias. On logistic regression, resting LV-GLS [odds ratio (OR), 1.40, 95% confidence interval (CI): 1.21–1.55, BMI (OR, 1.11, 95% CI: 1.06–1.17)] and resting RVSP 1.22 (1.02–1.49) were independent predictors of exercise capacity. Area under the curve for association between 100% age-gender predicted METs and various factors were as follows: (I) BMI (0.60, 95% CI: 0.55–0.65, P<0.001); (II) resting RVSP (0.57, 95% CI: 0.52–0.62, P=0.006) and LV-GLS (0.66, 95% CI: 0.61–0.70, P<0.001). Conclusions: In asymptomatic patients with ≥3+ primary MR, non-dilated LV and preserved LVEF, LV-GLS is independently associated with exercise capacity, beyond known predictors. %U https://cdt.amegroups.org/article/view/19691 %V 8 %N 4 %P 460-468 %@ 2223-3660