Exercise pulmonary hypertension in asymptomatic degenerative mitral regurgitation

in Circulation (2010), 122(1), 33-41

BACKGROUND: Current guidelines recommend mitral valve surgery for asymptomatic patients with severe degenerative mitral regurgitation and preserved left ventricular systolic function when exercise ... [more ▼]

BACKGROUND: Current guidelines recommend mitral valve surgery for asymptomatic patients with severe degenerative mitral regurgitation and preserved left ventricular systolic function when exercise pulmonary hypertension (PHT) is present. However, the determinants of exercise PHT have not been evaluated. The aim of this study was to identify the echocardiographic predictors of exercise PHT and the impact on symptoms. <br /> <br />METHODS AND RESULTS: Comprehensive resting and exercise transthoracic echocardiography was performed in 78 consecutive patients (age, 61+/-13 years; 56% men) with at least moderate degenerative mitral regurgitation (effective regurgitant orifice area =43+/-20 mm(2); regurgitant volume =71+/-27 mL). Exercise PHT was defined as a systolic pulmonary arterial pressure (SPAP) >60 mm Hg. Exercise PHT was present in 46% patients. In multivariable analysis, exercise effective regurgitant orifice was an independent determinant of exercise SPAP (P<0.0001) and exercise PHT (P=0.002). Resting PHT and exercise PHT were associated with markedly reduced 2-year symptom-free survival (36+/-14% versus 59+/-7%, P=0.04; 35+/-8% versus 75+/-7%, P<0.0001). After adjustment, although the impact of resting PHT was no longer significant, exercise PHT was identified as an independent predictor of the occurrence of symptoms (hazard ratio=3.4; P=0.002). Receiver-operating characteristics curves revealed that exercise PHT (SPAP >56 mm Hg) was more accurate than resting PHT (SPAP >36 mm Hg) in predicting the occurrence of symptoms during follow-up (P=0.032). <br /> <br />CONCLUSIONS: Exercise PHT is frequent in patients with asymptomatic degenerative mitral regurgitation. Exercise mitral regurgitation severity is a strong independent predictor of both exercise SPAP and exercise PHT. Exercise PHT is associated with markedly low 2-year symptom-free survival, emphasizing the use of exercise echocardiography. An exercise SPAP >56 mm Hg accurately predicts the occurrence of symptoms. [less ▲]

Exercise Pulmonary Hypertension in Asymptomatic Severe Aortic Stenosis.

Conference (2011)

Exercise pulmonary hypertension predicts the occurrence of symptoms in asymptomatic degenerative mitral regurgitation.

Conference (2011)

Exercise systolic pulmonary arterial pressure is the main determinant of maximal exercise capacity in asymptomatic patients with primary MR

Conference (2012)

Exercise-induced changes in degenerative mitral regurgitation

in Journal of the American College of Cardiology (2010), 56(4), 300-309

OBJECTIVES: We sought to quantify exercise-induced changes in patients with degenerative mitral regurgitation (MR), to examine the relationship between exercise-induced changes in MR and in systolic ... [more ▼]

OBJECTIVES: We sought to quantify exercise-induced changes in patients with degenerative mitral regurgitation (MR), to examine the relationship between exercise-induced changes in MR and in systolic pulmonary artery pressure (PAP), and to identify their potential impact on symptom-free survival. BACKGROUND: MR severity can change during exercise in patients with functional MR. Quantified changes in MR severity during exercise remain undetermined in patients with degenerative MR. METHODS: Resting and bicycle exercise Doppler-echocardiography were performed in 61 asymptomatic patients (age 62+/-14 years) with moderate to severe degenerative MR (i.e., mitral valve prolapse or flail). Mitral regurgitation was quantified at rest and exercise with effective regurgitant orifice (ERO) area and regurgitant volume calculated with the proximal isovelocity surface area (EROP) and the quantitative Doppler (EROD) methods. RESULTS: At rest, EROP and EROD were well-correlated (r=0.87, p<0.0001), but EROD was larger than EROP (54+/-21 mm2 vs. 42+/-24 mm2, p<0.0001). During exercise, mean ERO and regurgitant volume markedly increased in 32% of patients by >or=10 mm2 and >or=15 ml, respectively. There was good correlation between exercise EROP and EROD (r=0.84, p<0.0001). Changes in systolic PAP were correlated with changes in ERO and regurgitant volume (r=0.59, p=0.02 and r=0.60, p=0.02). Patients with a marked increase in regurgitant volume during exercise had lower symptom-free survival than those in whom MR decreased or remained unchanged (p=0.0015). CONCLUSIONS: Degenerative MR might be dynamic and increases during exercise in one-third of patients. Marked changes in MR severity are associated with exercise-induced changes in systolic PAP and reduced symptom-free survival. [less ▲]

Exercise-induced oxidative stress in overweight adolescent girls: roles of basal insulin resistance and inflammation and oxygen overconsumption.

in International Journal of Obesity & Related Metabolic Disorders (2009), 33(4), 447-55

HYPOTHESIS: Basal insulin resistance (IR) and inflammation exacerbate post-exercise oxidative stress (OS) in overweight adolescent girls. DESIGN: Cross-sectional study, effect of incremental ergocycle ... [more ▼]

HYPOTHESIS: Basal insulin resistance (IR) and inflammation exacerbate post-exercise oxidative stress (OS) in overweight adolescent girls. DESIGN: Cross-sectional study, effect of incremental ergocycle exercise until exhaustion on OS markers. PARTICIPANTS: Normal-weight (control) (n=17, body mass index (BMI): 20-24.2 kg/m(2)) and overweight adolescent girls (n=29, BMI: 24.1-36.6 kg/m(2)). MEASUREMENTS: Dietary measurement, physical activity assessment (validated questionnaires), fat distribution parameters (by dual-energy X-ray absorptiometry and anthropometry) and maximal oxygen consumption (VO2peak). Blood assays include the following: (1) at fasting state: blood cell count, lipid profile, and IR parameters (leptin/adiponectin ratio (L/A), homeostasis model assessment of IR, insulin/glucose ratio; (2) before exercise: inflammation and OS markers (interleukin-6 (IL-6), C-reactive protein (CRP), myeloperoxidase (MPO), reduced glutathione/oxidized glutathione ratio (GSH/GSSG), 15 F(2)alpha-isoprostanes (F(2)-Isop), lipid hydroperoxides (ROOH), oxidized low-density lipoprotein (ox-LDL)) and antioxidant status (superoxide dismutase (SOD), glutathione peroxidase (GPX), vitamin C, alpha-tocopherol and beta-carotene); and (3) after exercise: inflammation and OS markers. RESULTS: At rest, overweight girls had a deteriorated lipid profile and significantly higher values of IR parameters and inflammation markers, compared with the control girls. These alterations were associated with a moderate rest OS state (lower GSH/GSSG ratio, alpha-tocopherol/total cholesterol (TC) ratio and GPX activity). In absolute values, overweight girls exhibited higher peak power output and oxygen consumption (VO2peak), compared with the control girls. Exercise exacerbated OS only in the overweight group (significant increase in F(2)-Isop, ROOH and MPO). As hypothesized, basal IR and inflammation state were correlated with the post-exercise OS. However, the adjustment of F(2)-Isop, ROOH and MPO variation per exercise VO(2) variation canceled the intergroup differences. CONCLUSION: In overweight adolescent girls, the main factors of OS, after incremental exhaustive exercise, are not the basal IR and inflammation states, but oxygen overconsumption. [less ▲]

Exercise-induced pulmonary perfusion redistribution in heaves

in Equine Veterinary Journal. Supplement (2002), 34(suppl), 478-484

This study aimed to compare exercise-induced pulmonary perfusion redistribution in healthy vs. 'heavey' horses using scintigraphy, a minimally invasive technique. Six healthy (A) and 5 'heavey' horses in ... [more ▼]

This study aimed to compare exercise-induced pulmonary perfusion redistribution in healthy vs. 'heavey' horses using scintigraphy, a minimally invasive technique. Six healthy (A) and 5 'heavey' horses in remission (B(I)) and during clinical signs of disease (B(II)) were investigated. Dimensions of the exercising pulmonary perfusion (QE) images were expressed in percent of the resting perfusion (QR) images. Computed QE to QR ratios (QE/QR) images enabled the definition of the region more perfused at exercise than at rest (R1). In all groups, exercise induced a major enlargement of the Q image but a larger increase of the lung height was found in 'heavey' horses. Compared to A, 'heavey' horses showed a larger R1 region with a significantly higher QE/QR. Location of R1 pointed out the dorsal lung region as a major site of pulmonary perfusion redistribution for all groups. This work demonstrated (1) the feasibility of using scintigraphy for studying exercise-induced pulmonary perfusion redistribution; (2) perfusion redistribution to the dorsal lung with exercise and (3) an intensified redistribution in 'heavey' horses, either clinically affected or not. [less ▲]

Exérèse microchirurgicale atraumatique intranodulaire d'un schwanome bénin du sciatique poplité externe

in Actualités chirurgicales - 81ème Congrès Fr. Chirurgie, Orthopédie, Traumatologie (1980)

Exfoliated polylactide/clay nanocomposites by in-situ coordination-insertion polymerization

in Macromolecular Rapid Communications (2003), 24(9), 561-566

Poly(L-lactide)/layered aluminosilicate nanocomposites were synthesized in bulk by ring-opening polymerization in the presence of two organo-modified montmorillonites. When the organo-modifier consisted ... [more ▼]

Poly(L-lactide)/layered aluminosilicate nanocomposites were synthesized in bulk by ring-opening polymerization in the presence of two organo-modified montmorillonites. When the organo-modifier consisted of an ammonium cation bearing primary hydroxyl groups, polymerization was initiated by the alcohol functions after adequate activation. The growing polymer chains were directly "grafted" onto the clay surface through the hydroxyl-functionalized ammonium cations yielding exfoliated nano-composites with enhanced thermal stability. [less ▲]

Exforge® (amlodipine/valsartan combination) in hypertension: the evidence of its therapeutic impact

in Core Evidence (2008), 3(2), 117-126

Abstract Introduction: Hypertension is an important risk factor for cardiovascular disease and its management requires improvement. New treatment strategies are needed. Aims: This review analyses one of ... [more ▼]

Abstract Introduction: Hypertension is an important risk factor for cardiovascular disease and its management requires improvement. New treatment strategies are needed. Aims: This review analyses one of these strategies, which is the development of effective and safe combination therapy. Indeed, at least two antihypertensive agents are often needed to achieve blood pressure control. Exforge® (Novartis) is a new drug combination of the calcium channel blocker, amlodipine, and the angiotensin II receptor blocker, valsartan. Evidence review: The amlodipine/valsartan combination is an association of two well-known antihypertensive products with specific targets in cardiovascular protection, namely calcium channel blockade and antagonism of the renin-angiotensin-aldosterone system. This kind of association, with neutral metabolic properties and significant antihypertensive efficacy, could be a useful new antihypertensive product. Currently available data have shown that this new combination is well-tolerated and effective even in severe hypertension. Clinical value: Clinical trials are ongoing for further assessment of the efficacy, compliance, and safety of this combination and its congeners. No data exist to prove that the amlodipine/valsartan combination is better than other antihypertensive strategies for cardiovascular or renal protection, but some trials with other combination therapies show such potential advantage. [less ▲]