![bullet](_themes/strtedge/astrbul1e.gif) | Target patient group: Stage B and C of primary (degenerative)
mitral regurgitation; no specific guidelines given for secondary
(functional) MR.
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![bullet](_themes/strtedge/astrbul1e.gif) | Indication:
![bullet](_themes/strtedge/strbul2e.gif) | Exercise hemodynamics with either Doppler echocardiography or
cardiac catheterization is reasonable in symptomatic patients with
chronic primary MR where there is a discrepancy between symptoms and the
severity of MR at rest (stages B and C) |
![bullet](_themes/strtedge/strbul2e.gif) | Exercise treadmill testing can be useful in patients with chronic
primary MR to establish symptom status and exercise tolerance (stages B
and C). |
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![bullet](_themes/strtedge/astrbul1e.gif) | Contraindication: General contraindications for exercise stress
testing. |
![bullet](_themes/strtedge/astrbul1e.gif) | Evidence: Class IIA; evidence B |
![bullet](_themes/strtedge/astrbul1e.gif) | Monitoring: Supervision by physician or physician assistant as
per protocol for other stress tests. |
![bullet](_themes/strtedge/astrbul1e.gif) | When to stop exercise (Positive exercise echo end-points in
mitral regurgitation):
![bullet](_themes/strtedge/strbul2e.gif) | Symptoms: Exercise-induced dyspnea |
![bullet](_themes/strtedge/strbul2e.gif) | MR specific echo parameters:
![bullet](_themes/strtedge/strbul3e.gif) | Worsening MR |
![bullet](_themes/strtedge/strbul3e.gif) | Increase in PA systolic pressure (specific cutoff value not given
in guidelines; exercise PASP > 60 mm Hg is used in some studies)
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![bullet](_themes/strtedge/astrbul1e.gif) | Interpretation: A patient with a positive stress echo using
above criteria becomes a stage D patient and should be considered for MV
repair or replacement. |