Effect of Exercise on Left Atrium Mechanics in Mild Mitral Stenosis.

Müge Akbulut, Cansın Tulunay Kaya, Türkan Seda Tan, Demet Menekşe Gerede Uludağ, Çetin Erol
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Abstract

Objective: A significant number of individuals with mild mitral stenosis (MS) experience exertional symptoms that are disproportionate to the hemodynamic severity of their condition. This study aims to determine whether exercise-induced left atrial (LA) dysfunction occurs in these patients and whether it is related to the development of symptoms.

Methods: In this observational study, we recruited 46 patients with mild MS. Echocardiographic measurements were initially taken at rest, followed by a maximal exercise stress test. Patients were then returned to the echocardiography laboratory for post-exercise measurements.

Results: Our study cohort exhibited considerably higher left atrial volume index (LAVI) values (mean: 40.52 ± 18.27) compared to those of a healthy population. Furthermore, the LA reservoir strain (mean: 17.1 ± 8.33) was reduced relative to reference values. Following exercise, there was no change in the LA reservoir strain. However, trans-mitral pressure gradients and systolic pulmonary artery pressures increased. The post-exercise mean trans-mitral gradient was identified as the sole predictor of symptom development in patients with mild MS.

Conclusion: The LA reservoir strain is already reduced in individuals with mild MS, and exercise does not lead to further decline in LA reservoir function in these cases. To our knowledge, this study is the first to explore the effects of exercise on LA mechanics in MS.

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运动对轻度二尖瓣狭窄患者左心房力学的影响
目的:相当多的轻度二尖瓣狭窄(MS)患者会出现与其血流动力学严重程度不相称的劳累症状。本研究旨在确定这些患者是否会出现运动诱发的左心房(LA)功能障碍,以及它是否与症状的出现有关:在这项观察性研究中,我们招募了 46 名轻度多发性硬化症患者。首先在静息状态下进行超声心动图测量,然后进行最大运动负荷试验。然后患者返回超声心动图实验室进行运动后测量:与健康人群相比,我们的研究队列显示出更高的左心房容积指数(LAVI)值(平均值:40.52 ± 18.27)。此外,与参考值相比,左心房储层应变(平均值:17.1 ± 8.33)有所降低。运动后,LA 储库应变没有变化。然而,跨瓣膜压力梯度和肺动脉收缩压有所增加。运动后平均跨瓣膜梯度被确定为轻度多发性硬化症患者症状发展的唯一预测指标:结论:轻度多发性硬化症患者的 LA 储库应变已经降低,在这些病例中,运动不会导致 LA 储库功能进一步下降。据我们所知,该研究首次探讨了运动对多发性硬化症患者 LA 力学的影响。
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