{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T15:49:04Z","timestamp":1792511344532,"version":"4.5.0"},"reference-count":28,"publisher":"BMJ","issue":"10","funder":[{"DOI":"10.13039\/501100018950","name":"CHU RENNES","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100018950","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Heart"],"accepted":{"date-parts":[[2017,10,25]]},"published-print":{"date-parts":[[2018,5]]},"abstract":"<jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>To assess if the lack of development of right ventricular (RV) contractile reserve during exercise echocardiography (ex-echo) might be a predictor of postoperative major adverse cardiovascular events (MACEs) in patients with primary mitral regurgitation (pMR) undergoing early surgery.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Comprehensive resting and ex-echo were performed in 142 asymptomatic patients (58\u00b121 years, 68% men, New York Heart Association functional class \u22642) with isolated severe pMR and preserved left ventricular (LV) function (LV ejection &gt;60%, LV end-systolic diameter &lt;45\u2009mm) undergoing mitral valve replacement (n=20) or repair. Postoperative MACEs were defined as occurrence of atrial fibrillation, stroke, cardiac-related hospitalisation or death. RV function was evaluated at rest in every patient during ex-echo by measuring their tricuspid annular plane systolic excursion (TAPSE) value.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>After median follow-up of 30\u2009months (IQR 16\u201360 months), MACEs occurred in 48 (34%) patients. Using Bayesian model averaging, among all the characteristics including the type of surgery, exercise TAPSE (ex-TAPSE) emerged as the most likely predictor of prognosis (HR 0.91, 95%\u2009CI 0.86 to 0.96). Other probable predictors were exercise fractional area change (HR 0.02, 95%\u2009CI 0.00 to 0.80), male gender (HR 0.40, 95%\u2009CI 0.21 to 0.75) and RV basal diameter (HR 1.06, 95%\u2009CI 0.98 to 1.14). In the receiver operating characteristic curve analysis, an ex-TAPSE value of &lt;26\u2009mm (sensitivity 73% (95% CI 61 to 84) and specificity of 86% (95% CI 77% to 93%)) defined RV dysfunction. Event-free survival at 5\u2009years was significantly lower in the patient group that exhibited no development of RV contractile reserve during exercise: 43.9% (95% CI 31.3 to 61.4) vs 75.8% (95% CI 64.8 to 88.7).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Lack of development of exercise-induced RV contractile reserve is a prognostic predictor in patients with severe pMR undergoing early mitral valve surgery.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/heartjnl-2017-312097","type":"journal-article","created":{"date-parts":[[2017,12,5]],"date-time":"2017-12-05T12:15:24Z","timestamp":1512476124000},"page":"855-860","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":20,"title":["Right ventricular exercise contractile reserve and outcomes after early surgery for primary mitral regurgitation"],"prefix":"10.1136","volume":"104","author":[{"given":"Emilie","family":"Vitel","sequence":"first","affiliation":[{"name":"Service de Cardiologie et Maladies Vasculaires, CHU Rennes, Rennes, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elena","family":"Galli","sequence":"additional","affiliation":[{"name":"Service de Cardiologie et Maladies Vasculaires, CHU Rennes, Rennes, France"},{"name":"Universit\u00e9 Rennes-1, INSERM 1099, Rennes, France"},{"name":"LTSI, Universit\u00e9 de Rennes 1, Rennes, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christophe","family":"Leclercq","sequence":"additional","affiliation":[{"name":"Service de Cardiologie et Maladies Vasculaires, CHU Rennes, Rennes, France"},{"name":"Universit\u00e9 Rennes-1, INSERM 1099, Rennes, France"},{"name":"LTSI, Universit\u00e9 de Rennes 1, Rennes, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maxime","family":"Fournet","sequence":"additional","affiliation":[{"name":"Service de Cardiologie et Maladies Vasculaires, CHU Rennes, Rennes, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Bosseau","sequence":"additional","affiliation":[{"name":"Service de Cardiologie et Maladies Vasculaires, CHU Rennes, Rennes, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Herv\u00e9","family":"Corbineau","sequence":"additional","affiliation":[{"name":"Universit\u00e9 Rennes-1, INSERM 1099, Rennes, France"},{"name":"LTSI, Universit\u00e9 de Rennes 1, Rennes, France"},{"name":"Centre de Donn\u00e9es Cliniques, CHU Rennes, Rennes, France"},{"name":"Department of Cardiovascular and Thoracic Surgery, CHU Rennes, Rennes, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guillame","family":"Bouzille","sequence":"additional","affiliation":[{"name":"Universit\u00e9 Rennes-1, INSERM 1099, Rennes, France"},{"name":"LTSI, Universit\u00e9 de Rennes 1, Rennes, France"},{"name":"Centre de Donn\u00e9es Cliniques, CHU Rennes, Rennes, France"},{"name":"CIC et CIC--IT Inserm 1414, CHU Rennes, Rennes, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erwan","family":"Donal","sequence":"additional","affiliation":[{"name":"Service de Cardiologie et Maladies Vasculaires, CHU Rennes, Rennes, France"},{"name":"Universit\u00e9 Rennes-1, INSERM 1099, Rennes, France"},{"name":"LTSI, Universit\u00e9 de Rennes 1, Rennes, France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2017,12,5]]},"reference":[{"key":"2025092005532840000_104.10.855.1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehs109"},{"key":"2025092005532840000_104.10.855.2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.105.599175"},{"key":"2025092005532840000_104.10.855.3","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2013.8643"},{"key":"2025092005532840000_104.10.855.4","doi-asserted-by":"publisher","DOI":"10.1093\/ehjci\/jet105"},{"key":"2025092005532840000_104.10.855.5","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.110.938241"},{"key":"2025092005532840000_104.10.855.6","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2014-306296"},{"key":"2025092005532840000_104.10.855.7","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.112.000999"},{"key":"2025092005532840000_104.10.855.8","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1093\/ejechocard\/jen247","article-title":"Right ventricular dilatation predicts survival after mitral valve repair in patients with impaired left ventricular systolic function","volume":"10","author":"Chrustowicz","year":"2009","journal-title":"Eur J Echocardiogr"},{"key":"2025092005532840000_104.10.855.9","doi-asserted-by":"publisher","DOI":"10.1093\/ehjci\/jev014"},{"key":"2025092005532840000_104.10.855.10","doi-asserted-by":"publisher","DOI":"10.1093\/ehjci\/jew190"},{"key":"2025092005532840000_104.10.855.11","doi-asserted-by":"publisher","DOI":"10.1093\/ehjci\/jes068"},{"key":"2025092005532840000_104.10.855.12","first-page":"433","article-title":"Bayesian model averaging in proportional hazards models : assessing the risk of a stroke","volume":"46","author":"","year":"1997","journal-title":"Appl Stat"},{"key":"2025092005532840000_104.10.855.13","unstructured":"R Core Team. \u00a0A language and environment for statistical computing. Vienna, Austria: R Foundation for Statistical Computing, 2017."},{"key":"2025092005532840000_104.10.855.14","doi-asserted-by":"publisher","DOI":"10.1111\/j.0006-341X.2000.00337.x"},{"key":"2025092005532840000_104.10.855.15","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehu193"},{"key":"2025092005532840000_104.10.855.16","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.113.002518"},{"key":"2025092005532840000_104.10.855.17","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCIMAGING.109.914366"},{"key":"2025092005532840000_104.10.855.18","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2008.11.051"},{"key":"2025092005532840000_104.10.855.19","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2014.09.062"},{"key":"2025092005532840000_104.10.855.20","doi-asserted-by":"publisher","DOI":"10.1016\/j.echo.2004.01.010"},{"key":"2025092005532840000_104.10.855.21","doi-asserted-by":"publisher","DOI":"10.1016\/j.euje.2005.10.009"},{"key":"2025092005532840000_104.10.855.22","doi-asserted-by":"publisher","DOI":"10.1016\/j.cardfail.2011.12.003"},{"key":"2025092005532840000_104.10.855.23","doi-asserted-by":"crossref","first-page":"508","DOI":"10.1111\/echo.12417","article-title":"Objective measures of right ventricular function during exercise: results of a pilot study","volume":"31","author":"Anjak","year":"2014","journal-title":"Echocardiography"},{"key":"2025092005532840000_104.10.855.24","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2013.10.033"},{"key":"2025092005532840000_104.10.855.25","doi-asserted-by":"publisher","DOI":"10.1093\/ehjci\/jeu290"},{"key":"2025092005532840000_104.10.855.26","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2016.10.047"},{"key":"2025092005532840000_104.10.855.27","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201412-2271OC"},{"key":"2025092005532840000_104.10.855.28","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCIMAGING.112.000162"}],"container-title":["Heart"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/heartjnl-2017-312097","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,20]],"date-time":"2025-09-20T12:53:33Z","timestamp":1758372813000},"score":1,"resource":{"primary":{"URL":"https:\/\/heart.bmj.com\/lookup\/doi\/10.1136\/heartjnl-2017-312097"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,12,5]]},"references-count":28,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2018,4,26]]},"published-print":{"date-parts":[[2018,5]]}},"alternative-id":["10.1136\/heartjnl-2017-312097"],"URL":"https:\/\/doi.org\/10.1136\/heartjnl-2017-312097","relation":{},"ISSN":["1355-6037","1468-201X"],"issn-type":[{"value":"1355-6037","type":"print"},{"value":"1468-201X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,12,5]]}}}