{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,21]],"date-time":"2026-01-21T04:40:23Z","timestamp":1768970423599,"version":"3.49.0"},"reference-count":25,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2019,3,5]]},"abstract":"\n Background<\/jats:title>\n \n Mitral regurgitation (\n MR<\/jats:styled-content>\n ) has the potential to impede exercise capacity; it is uncertain whether this is because of regurgitation itself or the underlying cause of valvular insufficiency.\n <\/jats:p>\n <\/jats:sec>\n \n Methods and Results<\/jats:title>\n \n The population comprised 3267 patients who underwent exercise treadmill myocardial perfusion imaging and transthoracic echocardiography within 6\u00b18\u00a0days.\n MR<\/jats:styled-content>\n was present in 28%, including 176 patients (5%) with moderate or greater\n MR<\/jats:styled-content>\n . Left ventricular systolic function significantly decreased and chamber size increased in relation to\n MR<\/jats:styled-content>\n , paralleling increments in stress and rest myocardial perfusion deficits (all\n P<\/jats:italic>\n <0.001). Exercise tolerance (metabolic equivalents of task) decreased stepwise in relation to graded\n MR<\/jats:styled-content>\n severity (\n P<\/jats:italic>\n <0.05). Workload was significantly lower with mild versus no\n MR<\/jats:styled-content>\n (mean\u00b1SD, 9.8\u00b13.0 versus 10.1\u00b13.0;\n P<\/jats:italic>\n =0.02); magnitude of workload reduction significantly increased among patients with advanced versus those with mild\n MR<\/jats:styled-content>\n (mean\u00b1SD, 8.6\u00b13.0 versus 9.8\u00b13.0;\n P<\/jats:italic>\n <0.001).\n MR<\/jats:styled-content>\n \u2010associated exercise impairment was accompanied by lower heart rate and blood pressure augmentation and greater dyspnea (all\n P<\/jats:italic>\n <0.05). Both functional and nonfunctional\n MR<\/jats:styled-content>\n subgroups demonstrated significantly decreased effort tolerance in relation to\n MR<\/jats:styled-content>\n severity (\n P<\/jats:italic>\n \u22640.01); impairment was greater with functional\n MR<\/jats:styled-content>\n (\n P<\/jats:italic>\n =0.04) corresponding to more advanced left ventricular dysfunction and dilation (both\n P<\/jats:italic>\n <0.001). Functional\n MR<\/jats:styled-content>\n predicted reduced metabolic equivalent of task\u2013based effort (B=\u22120.39 [95% CI, \u22120.62 to \u22120.17];\n P<\/jats:italic>\n =0.001) independent of\n MR<\/jats:styled-content>\n severity. Among the overall cohort, advanced (moderate or greater)\n MR<\/jats:styled-content>\n was associated with reduced effort tolerance (B=\u22121.36 [95% CI, \u22121.80 to \u22120.93];\n P<\/jats:italic>\n <0.001) and remained significant (\n P<\/jats:italic>\n =0.01) after controlling for age, clinical indexes, stress perfusion defects, and left ventricular dysfunction.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n \n MR<\/jats:styled-content>\n impairs exercise tolerance independent of left ventricular ischemia, dysfunction, and clinical indexes. Magnitude of exercise impairment parallels severity of\n MR<\/jats:styled-content>\n .\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1161\/jaha.118.010974","type":"journal-article","created":{"date-parts":[[2019,2,27]],"date-time":"2019-02-27T10:00:21Z","timestamp":1551261621000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":7,"title":["Impact of Mitral Regurgitation Severity and Cause on Effort Tolerance\u2013Integrated Stress Myocardial Perfusion Imaging and Echocardiographic Assessment of Patients With Known or Suspected Coronary Artery Disease Undergoing Exercise Treadmill Testing"],"prefix":"10.1161","volume":"8","author":[{"given":"Polydoros N.","family":"Kampaktsis","sequence":"first","affiliation":[{"name":"Department of Medicine Weill Cornell Medical College New York NY"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Benjamin J.","family":"Albert","sequence":"additional","affiliation":[{"name":"Department of Biomedical Engineering Cornell University Ithaca NY"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jiwon","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Medicine Weill Cornell Medical College New York NY"},{"name":"Department of Medicine and Radiology Weill Cornell Medical College New York NY"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lola X.","family":"Xie","sequence":"additional","affiliation":[{"name":"Memorial Sloan Kettering Cancer Center New York NY"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lillian R.","family":"Brouwer","sequence":"additional","affiliation":[{"name":"Department of Medicine Weill Cornell Medical College New York NY"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nathan H.","family":"Tehrani","sequence":"additional","affiliation":[{"name":"Department of Medicine Weill Cornell Medical College New York 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