Measuring heart function during exercise may reveal risks not evident at rest. A study in Circulation found that the exercise-derived TAPSE/sPAP ratio predicts outcomes more effectively than resting measures in primary MR.

The international multicenter study enrolled 357 patients with moderate or severe primary MR who underwent cardiopulmonary exercise testing with echocardiography. TAPSE/sPAP was measured at rest and during exercise to assess right ventricular response to increased workload.

Patients with an intermediate exTAPSE/sPAP value below 0.6 mm/mmHg had significantly lower event-free survival and a higher risk of cardiovascular complications. The parameter independently predicted adverse outcomes, including cardiovascular death, unplanned hospitalization, and new-onset atrial fibrillation, even after adjustment for age, MR severity, and resting function.

Because intermediate exTAPSE/sPAP was easier to obtain and equally accurate as peak measurements, it may serve as a practical and feasible marker for early risk stratification. Incorporating this exercise-based metric could help identify high-risk patients and optimize the timing of mitral valve intervention.