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Exercise stress echocardiography reveals pulmonary congestion in patients with severe mitral regurgitation undergoing transcatheter edge-to-edge mitral valve repair

https://doi.org/10.1007/s00392-025-02625-4

Christine Meindl (Regensburg)1, J. Kohler (Regensburg)1, M. Schindler (Regensburg)1, S. Bauer (Vöcklabruck)2, F. Grewe (Regensburg)1, M. Haus (Regensburg)1, P. Felfeli (Regensburg)1, M. Wester (Regensburg)1, C. Schach (Regensburg)1, A. Luchner (Regensburg)3, L. S. Maier (Regensburg)1, C. Birner (Amberg)4, B. Unsöld (Gießen)5, M. Paulus (Regensburg)1, K. Debl (Regensburg)1

1Universitätsklinikum Regensburg Klinik und Poliklinik für Innere Med. II, Kardiologie Regensburg, Deutschland; 2Salzkammergut Klinikum Vöcklabruck Klinik für Kardiologie und Intensivmedizin Vöcklabruck, Österreich; 3Krankenhaus Barmherzige Brüder Regensburg Klinik für Kardiologie Regensburg, Deutschland; 4Klinikum St. Marien Klinik für Innere Medizin I Amberg, Deutschland; 5Universitätsklinikum Gießen und Marburg GmbH Medizinische Klinik I - Kardiologie und Angiologie Gießen, Deutschland

 

Background
Lung ultrasound (LUS) is a well established tool to reveal pulmonary congestion. The appearance of B-lines detected by LUS during exercise stress echocardiography in patients with severe mitral regurgitation undergoing transcatheter edge-to-edge mitral valve repair (M-TEER) has not been studied yet.

Methods and results
We enrolled 54 patients with symptomatic moderate to severe or severe mitral regurgitation undergoing M-TEER in a prospective single-centre study. 35 patients with preserved ejection fraction and without relevant mitral regurgitation served as a control group. B-lines were assessed by   LUS  at rest, at peak exercise and post exercise stress echocardiography using the 4-site simplified scan. In order to quantify the occurence of B-lines a score from 0-3 for each site was assigned (0: absence of B-lines, 1: <5 B-lines, 2: 5-10 B-lines, 3: >10 B-lines). Patients with severe mitral regurgitation had to stop exercise stress echocardiography earlier compared to the control group (75 [50-100] W vs. 125 [100-150] W, p<0.001). Systolic pulmonary artery pressure (sPAP) was significantly higher in patients with severe mitral regurgitation at rest (35 ± 13 mmHg vs. 24 ± 4 mmHg, p<0.001) as well as at peak exercise (56 ± 16 mmHg vs. 45 ± 9 mmHg, p<0.001). B-Lines score increased from rest to peak exercise in both groups (p<0.001 in patients, p=0.021 in controls). Patients with severe mitral regurgitation had higher B-lines score values at rest (2.0 ± 2.3 vs. 0.1 ± 0.5, p<0.001) as well as at peak exercise (5.6 ± 4.0 vs. 0.4 ± 1.0, p<0.001) than the control group.

Conclusion
Exercise stress echocardiography detects pulmonary congestion in patients with severe mitral regurgitation. This finding could be a useful tool in order to determine the indication and timing of M-TEER.

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