Usefulness of latent left ventricular dysfunction assessed by Bowditch Treppe to predict stress induced pulmonary hypertension in minimally symptomatic severe mitral regurgitation secondary to mitral valve prolapse

We assessed whether the presence of latent myocardial dysfunction, evaluated by echocardiographic derived force-frequency relationship (FFR) during exercise, predicts the appearance of stress-induced pulmonary hypertension in minimally symptomatic patients with severe mitral regurgitation (MR). Two groups of patients were identified: group I with normal (<40 mm Hg) and group II with abnormal (>40 mm Hg) peak stress systemic pulmonary artery pressure. Group I had normal and upsloping FFR and group II had abnormal flat or biphasic FFR. Therefore, in patients with severe MR and apparently normal left ventricular function, the stressinduced pulmonary hypertension seems to be related to the presence of latent left ventricular dysfunction.