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Cardiopulmonary Exercise Testing Determination of Functional Capacity in Mitral Regurgitation

Physiologic and Outcome Implications

David Messika-Zeitoun, MD^_*, Bruce D. Johnson, PhD^_*, Vuyisile Nkomo, MD^_*, Jean-François Avierinos, MD^_*, Thomas G. Allison, PhD^_*, Christopher Scott, MS, A. Jamil Tajik, MD^_* and Maurice Enriquez-Sarano, MD^_*,_*

^_* Division of Cardiovascular Diseases and Internal Medicine, Mayo College of Medicine, Rochester, Minnesota
Section of Biostatistics, Mayo College of Medicine, Rochester, Minnesota

View larger version (12K): [in a new window]   Figure 1 Example of exercise progression in two patients of similar age (57 and 59 years), degree of regurgitation (regurgitant volume of 77 and 78 ml/beat), and peak heart rate with exercise (156 vs. 153 beats/min). (A) Plot of peak-VO2 versus exercise time. The first patient (closed circles) displays normal functional capacity (normal peak VO2, 114% of predicted), whereas the second (open circles) has reduced functional capacity (reduced peak VO2, 68% of predicted), with plateau of O2 consumption toward the end of exercise. (B) Plot of respiratory exchange ratio (RER) versus exercise time in these two patients. Note that despite the marked differences in exercise capacity, both patients provide a maximum exercise effort with RER increasing above 1.1 (1.12 and 1.26 at peak exercise, respectively). (C) Plot of O2 pulse versus exercise time. The first patient with normal peak VO2 (closed circles) reaches a higher peak O2 pulse (18.3) versus that reached by the patient with reduced peak VO2 (open circles, 10.8) reflecting higher stroke volume with exercise. Also note the plateau in VO2 and O2 pulse in the patient with mitral regurgitation-related reduced peak VO2.

View larger version (13K): [in a new window]   Figure 2 Clinical outcome after cardiopulmonary exercise testing, displaying Kaplan-Meier curves according to the achieved functional capacity classified as normal (solid line) or reduced (dotted line) based on achieving above or below 84% of the expected VO2 for age, gender, and presence of excess weight. The end point measured is the incidence of either clinical events (death, heart failure, or new atrial arrhythmia) or the indication of mitral surgery. Note the significant excess event rate in patients with reduced functional capacity. The numbers associated with each line represent the three-year rate of event for each group.