Mitral Insufficiency
Conditions
Keywords
mitral regurgitation, symptoms, exercise capacity
Brief summary
The current American College of Cardiology/American Heart Association (ACC/AHA) guidelines recommend surgery in patient with mitral regurgitation (MR) based on 1) the severity of MR and 2) the presence or absence of symptoms. Studies have shown that Cardiovascular Magnetic Resonance (CMR) is an accurate method to quantify the severity of MR. However, studies have also shown that symptoms are not necessarily related to the presence of symptoms. Thus, there appears to be a disconnect between the severity of MR and symptoms. Recent analysis of our data has shown that females and older patients with smaller ventricles, lower stroke volumes, and lower regurgitant volume relative to regurgitant fraction tend to be symptomatic. These findings suggest that decreased left ventricular compliance, i.e. diastolic dysfunction, may play an important role as an etiology of symptoms in patients with mitral regurgitation. The aim of this study is to study the presence of diastolic dysfunction in patients with MR and its association with symptom burden and exercise capacity.
Detailed description
The study is an observational study of patients with mitral regurgitation undergoing LHC prior to mitral valve surgery or percutaneous mitral valve intervention. Prior to patients LHC they will undergo testing using CMR, CPET, and KCCQ. During the LHC, patients will undergo evaluation of intracardiac pressures and volumes using a specialized catheter which measures pressure and volume changes throughout the cardiac cycle. CMR- CMR evaluation will quantify mitral regurgitant volume and fraction, right and left atrial size and function, and myocardial scar quantification. CPET- objectively assess patients exercise capacity. KCCQ- is a standard questionnaire designed to assesses patients quality of life and symptom burden. LHC- Pressure-volume loops will be measured during LHC. This will quantify left ventricular compliance and assess patients for the presence of diastolic dysfunction. These evaluations will help us better understand the relationship between symptoms, exercise capacity, severity of MR and diastolic dysfunction.
Interventions
DIAGNOSTIC_TESTPressure volume loop evaluation
During the left heart catheterization there are catheters which are introduced into the left ventricle to measure left ventricular pressures and into the coronary arteries to assess their patency. This study will require the placement of an additional specialized catheter made into the left ventricle to measure the change of pressure and volume during the cardiac cycle. This will allow the measurement of heart muscle stiffness.
DIAGNOSTIC_TESTcardiovascular magnetic resonance imaging
Patients will undergo standard cardiovascular magnetic resonance imaging of their heart to measure their heart size, heart function, and severity of mitral regurgitation. In addition, contrast will be administered and heart tissue will be assessed for scarring or fibrosis.
DIAGNOSTIC_TESTCardiopulmonary exercise testing (CPET)
A CPET will be performed to objectively measure a patient ability to perform exercise.
DIAGNOSTIC_TESTKansas City Cardiomyopathy Questionairre
This is a short questionnaire which objectively quantifies symptom burden
Sponsors
Atlantic Health System
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
MALE
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Age \>=18 years of age * Able to give informed consent * Primary (degenerative) mitral regurgitation * LVEF \>=50% * Undergoing cardiac catheterization * Able to exercise on a treadmill
Exclusion criteria
* Unable to give informed consent * Secondary (functional) mitral regurgitation * LVEF \<50% * Known coronary artery stenosis \>=70% or past revascularization * More than mild aortic stenosis, mitral stenosis, aortic regurgitation, tricuspid regurgitation, or pulmonic regurgitation * Hypertrophic cardiomyopathy * Pregnancy
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Diastolic Dysfunction Symptoms/exercise capacity | Enrollment to testing completed 8 weeks | Assess the relationship between diastolic dysfunction. Diastolic dysfunction is measured by pressure volume loop assessment. Diastolic disfunction will be compared to patients symptom burden (as quantified by KCCQ) and exercise capacity (as quantified by CPET). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Mitral regurgitation severity and measures of diastolic dysfunction | enrollment to 8 weeks | MR volume and fraction compared to diastolic dysfunction as measured by pressure volume loop assessment |
Countries
United States
Contacts
Primary ContactMedical Director, Cardiovascular Imaging, MD
Outcome results
None listed