 | Target patient group: Stage B and C of primary (degenerative)
mitral regurgitation; no specific guidelines given for secondary
(functional) MR.
|
| Indication:
 | 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) |
| Exercise treadmill testing can be useful in patients with chronic
primary MR to establish symptom status and exercise tolerance (stages B
and C). |
|
| Contraindication: General contraindications for exercise stress
testing. |
| Evidence: Class IIA; evidence B |
| Monitoring: Supervision by physician or physician assistant as
per protocol for other stress tests. |
| When to stop exercise (Positive exercise echo end-points in
mitral regurgitation):
| Symptoms: Exercise-induced dyspnea |
| MR specific echo parameters:
 | Worsening MR |
| Increase in PA systolic pressure (specific cutoff value not given
in guidelines; exercise PASP > 60 mm Hg is used in some studies)
|
|
|
| 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. |
