J Card Fail. 2011 Oct;17(10):806-12. Epub 2011 Jul 23.

Functional mitral regurgitation: a link to pulmonary hypertension in heart failure with preserved ejection fraction.

Maréchaux S, Neicu DV, Braun S, Richardson M, Delsart P, Bouabdallaoui N, Banfi C, Gautier C, Graux P, Asseman P, Pibarot P, Le Jemtel TH, Ennezat PV; Lille HFpEF Study Group.

Source

Groupement Hospitalier de l'Institut Catholique Lillois/Faculté Libre de Médecine, Lille, France.

Abstract

BACKGROUND:

Patients with heart failure with preserved ejection fraction (HFpEF) may present with Pulmonary hypertension (PH) and functional mitral regurgitation (MR). Whether PH is linked to the presence of functional MR has not been investigated in HFpEF patients.

METHODS AND RESULTS:

Systolic pulmonary artery pressure (sPAP) and functional MR were assessed by 2-dimensional Doppler echocardiography in 70 ambulatory HFpEF patients and 70 hypertensive control subjects free of organic mitral valve lesions, significant valve disease, and comorbid conditions associated with PH. Whereas none of control subjects had more than trivial MR, 21 patients with HFpEF had functional MR (mean mitral effective regurgitant orifice, regurgitant volume, and regurgitant fraction 7 ± 3 mm,(2) 15 ± 8 mL, and 28 ± 14%, respectively). Pulmonary hypertension (sPAP >35 mm Hg) was significantly more prevalent in HFpEF patients with functional MR than in HFpEF patients without functional MR (62 vs 22%; P = .002). Functional MR remained an independent predictor of PH in HFpEF patients (P = .004) after adjustment on mitral E wave to e' mitral annulus velocity ratio (E/e'; P = .022) and left atrial volume index (P = .025). Systolic PAP and E/e' were greater in HFpEF patients than in control subjects (35 ± 9 vs 29 ± 8 mm Hg [P < .0001] and 13 ± 6 vs 11 ± 5 [P = .018], respectively). Systolic PAP remained greater in HFpEF patients than in control subjects after adjusting for E/e' (P = .002).

CONCLUSIONS:

Pulmonary hypertension appears to be linked to the presence of functional MR in HFpEF patients.

Nephrol Dial Transplant. 2011 Dec;26(12):3908-13. Epub 2011 Mar 18.

Renal resistance index and its prognostic significance in patients with heart failure with preserved ejection fraction.

Ennezat PV, Maréchaux S, Six-Carpentier M, Pinçon C, Sediri I, Delsart P, Gras M, Mounier-Véhier C, Gautier C, Montaigne D, Jude B, Asseman P, Le Jemtel TH.

Source

Division of Cardiology and Ultrasound, Universitaire de Lille, Lille, France. ennezat@yahoo.com

Abstract

BACKGROUND:

Functional renal impairment is a common feature of heart failure with preserved ejection fraction (HFpEF). The link between functional renal impairment and HFpEF remains incompletely understood. With hypertension and diabetes as frequent co-morbidities, patients with HFpEF are at risk of developing intra-renal vascular hemodynamic alterations that may lead to functional renal impairment and impact on prognosis.

METHODS:

Renal resistive index (RRI) was non-invasively determined by Doppler ultrasonic examination in 90 HFpEF patients and 90 age- and sex-matched hypertensive patients without evidence of heart failure (HF) who served as controls. Clinical, laboratory and cardiac echocardiography data were obtained in HFpEF patients and controls. To investigate its possible clinical relevance, RRI was evaluated as a prognostic index of all-cause mortality and hospitalization for HF.

RESULTS:

Mean RRI was substantially greater in HFpEF patients than in controls (P < 0.0001), while mean blood pressure, glomerular filtration rate, hemoglobin and serum protein levels were significantly lower in HFpEF patients than in controls. On multivariable analysis, mean RRI was independently associated with HFpEF. In addition, increased mean RRI was an independent predictor of poor outcome [hazard ratio = 1.06 95% confidence interval (1.01-1.10), P = 0.007] and remained significantly associated with the outcome after adjustment for univariate predictors that included low mean blood pressure, low hemoglobin concentration and low glomerular filtration rate. Conclusion. Patients with HFpEF exhibit intra-renal vascular hemodynamic alterations. The severity of intra-renal vascular hemodynamic alterations correlates with a poor outcome.

Eur J Echocardiogr. 2010 May;11(4):E14. Epub 2009 Dec 3.

Exercise-induced functional mitral regurgitation in heart failure and preserved ejection fraction: a new entity.

Maréchaux S, Terrade J, Biausque F, Lefetz Y, Deturck R, Asseman P, Le Jemtel TH, Ennezat PV.

Source

Centre Hospitalier Régional et Universitaire de Lille, Service d'explorations fonctionnelles cardiovasculaires, Lille, France.

Abstract

We report here the worsening of functional mitral regurgitation (MR) during dynamic exercise Doppler echocardiography in four female patients with heart failure and preserved ejection fraction. MR worsened concomitantly to an increase in systolic mitral tenting area and in E/E(a) ratio, whereas local left ventricular (LV) remodelling was not substantially aggravated by exercise. We accordingly suggest that exercise-induced increase in LV filling or left atrial pressure that in turn leads to increase in mitral tenting area worsens functional MR during exercise.