PMID- 26228598 OWN - NLM STAT- MEDLINE DCOM- 20160106 LR - 20151005 IS - 1552-6259 (Electronic) IS - 0003-4975 (Linking) VI - 100 IP - 4 DP - 2015 Oct TI - Restrictive Mitral Annuloplasty Does Not Limit Exercise Capacity. PG - 1326-32 LID - S0003-4975(15)00632-3 [pii] LID - 10.1016/j.athoracsur.2015.04.028 [doi] AB - BACKGROUND: Restrictive mitral annuloplasty is the preferred method of treating secondary mitral regurgitation. The use of small annuloplasty rings to reduce the high recurrence rates may result in mitral stenosis. METHODS: Thirty-six patients who underwent restrictive mitral annuloplasty with Carpentier-Edwards classic 26 size ring underwent exercise echocardiography and ergospirometry. Resting catecholamines and N-terminal pro brain natriuretic peptide (NT-proBNP) levels were measured. RESULTS: At the time of study, the median time from operation was 16.6 months (interquartile range, 8.5 to 43.3 months). Left ventricular end-systolic volume index (LVESVI) was 67 mL/m(2) (interquartile range, 25 to 92 mL/m(2)), and ejection fraction (EF) was 38.8% (interquartile range, 28.3% to 59.0%). Mitral gradients were higher at the leaflet tips than at the annular level. Continuous wave (CW) Doppler gradients at rest were 3.4 mmHg (interquartile range, 2.4 to 4.9 mmHg) mean and 9.5 mmHg (interquartile range, 7.0 to 14.7 mmHg) maximal. On exertion, they increased to 6.8 mmHg (interquartile range, 5.4 to 8.8 mmHg) (p = 0.001) and 19.7 mmHg (interquartile range, 12.8 to 23.3 mmHg) (p = 0.001), respectively. Maximal VO2 was 18.2 mL/kg/min (interquartile range, 16.3 to 21.5 mL/kg/min), VE/VCO2 slope was 31.1 (interquartile range, 26 to 34). Epinephrine level was 0.024 ng/mL (interquartile range, 0.0098 to 0.043 ng/mL), norepinephrine was 0.61 ng/mL (interquartile range, 0.41 to 0.95 ng/mL), and NT-proBNP was 303 pg/mL (interquartile range, 155 to 553 pg/mL). Maximal VO2 negatively correlated with resting norepinephrine level (r = -0.50, p = 0.003). VE/VCO2 slope positively correlated with NT-proBNP (r = 0.36, p = 0.004) and epinephrine (r = 0.36, p = 0.04) levels and with LV volumes (r = 0.51, p = 0.006) and was negatively correlated with LVEF (r = -0.52, p = 0.004). Neither maximal VO2 nor VE/VCO2 slope correlated with the highest mean (r = 0.24, p = 0.2, and r = -0.20, p = 0.3, respectively) and maximal (r = 0.13, p = 0.5, r = -0.20, p = 0.3, respectively) mitral gradients on exertion. CONCLUSIONS: Restrictive mitral annuloplasty for secondary mitral regurgitation does result in a degree of mitral stenosis; however, primary heart disease seems more important for patient's exercise performance than the mitral stenosis resulting from using an undersized ring. CI - Copyright (c) 2015 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved. FAU - Deja, Marek A AU - Deja MA AD - Department of Cardiac Surgery, Medical University of Silesia, School of Medicine in Katowice and School of Health Sciences in Katowice, Katowice, Poland. Electronic address: mdeja@sum.edu.pl. FAU - Zak, Aleksandra AU - Zak A AD - Department of Cardiac Surgery, Medical University of Silesia, School of Medicine in Katowice and School of Health Sciences in Katowice, Katowice, Poland. FAU - Malinowski, Marcin AU - Malinowski M AD - Department of Cardiac Surgery, Medical University of Silesia, School of Medicine in Katowice and School of Health Sciences in Katowice, Katowice, Poland. FAU - Pysz, Piotr AU - Pysz P AD - 2nd Department of Cardiology, Medical University of Silesia, School of Medicine in Katowice and School of Health Sciences in Katowice, Katowice, Poland. FAU - Gaszewska-Zurek, Ewa AU - Gaszewska-Zurek E AD - 3rd Department of Cardiology, Medical University of Silesia, School of Medicine in Katowice and School of Health Sciences in Katowice, Katowice, Poland. FAU - Turski, Maciej AU - Turski M AD - 1st Department of Cardiology, Medical University of Silesia, School of Medicine in Katowice and School of Health Sciences in Katowice, Katowice, Poland. FAU - Janusiewicz, Piotr AU - Janusiewicz P AD - Department of Cardiac Surgery, Medical University of Silesia, School of Medicine in Katowice and School of Health Sciences in Katowice, Katowice, Poland. FAU - Wita, Krystian AU - Wita K AD - 1st Department of Cardiology, Medical University of Silesia, School of Medicine in Katowice and School of Health Sciences in Katowice, Katowice, Poland. FAU - Chudek, Jerzy AU - Chudek J AD - Department of Pathophysiology, Medical University of Silesia, School of Medicine in Katowice and School of Health Sciences in Katowice, Katowice, Poland. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20150728 PL - Netherlands TA - Ann Thorac Surg JT - The Annals of thoracic surgery JID - 15030100R RN - 0 (Peptide Fragments) RN - 0 (pro-brain natriuretic peptide (1-76)) RN - 114471-18-0 (Natriuretic Peptide, Brain) RN - X4W3ENH1CV (Norepinephrine) RN - YKH834O4BH (Epinephrine) SB - IM CIN - Ann Thorac Surg. 2015 Oct;100(4):1332-3. PMID: 26434432 MH - Aged MH - Epinephrine/blood MH - Exercise/*physiology MH - Exercise Test MH - Exercise Tolerance/physiology MH - Female MH - Humans MH - Male MH - Middle Aged MH - Mitral Valve Annuloplasty/*methods MH - Mitral Valve Insufficiency/*physiopathology/*surgery MH - Mitral Valve Stenosis/etiology MH - Natriuretic Peptide, Brain/blood MH - Norepinephrine/blood MH - Peptide Fragments/blood EDAT- 2015/08/01 06:00 MHDA- 2016/01/07 06:00 CRDT- 2015/08/01 06:00 PHST- 2014/11/30 00:00 [received] PHST- 2015/03/28 00:00 [revised] PHST- 2015/04/01 00:00 [accepted] PHST- 2015/08/01 06:00 [entrez] PHST- 2015/08/01 06:00 [pubmed] PHST- 2016/01/07 06:00 [medline] AID - S0003-4975(15)00632-3 [pii] AID - 10.1016/j.athoracsur.2015.04.028 [doi] PST - ppublish SO - Ann Thorac Surg. 2015 Oct;100(4):1326-32. doi: 10.1016/j.athoracsur.2015.04.028. Epub 2015 Jul 28.