EFFECTS OF AORTIC-VALVE REPLACEMENT ON EXERCISE DURATION AND FUNCTIONAL STATUS IN ADULTS WITH VALVULAR AORTIC-STENOSIS

OBJECTIVE: To evaluate the effect of aortic valve replacement on left ventricular function, functional status and exercise duration in an ad ult population with valvular aortic stenosis. DESIGN: Prospective stud y of initially asymptomatic patients with pre- and postvalve replaceme nt echocardiography, functional status score and exercise data. SETTIN G: University-affiliated, tertiary care teaching hospital. PATIENTS: V alvular aortic stenosis patients referred from academic and private pr actice internists and cardiologists (n=34,, 65% men, mean age 68+/-11 years, preoperative aortic valve area 0.9+/-0.4 cm(2)). INTERVENTIONS: Annual Doppler echocardiography, functional status questionnaires and , if possible, Bruce protocol maximal exercise tolerance tests. MAIN R ESULTS: Aortic valve replacement resulted in a decrease in maximum jet velocity (pre 4.7+/-0.7 versus post 2.9+/-0.7 m/s, P=0.0001) and left ventricular mass (pre 167+/-37 versus post 134+/-32 g, P=0.0001) and an increase in left ventricular ejection fraction (pre 65+/-11 versus post 69+/-10%, P=0.05) at rest. However, there was no change in the ra tio of early to atrial diastolic filling velocities (pre 1.2+/-0.5 ver sus post 1.4+/-0.8, not significant), exercise tolerance as assessed b y estimated functional aerobic impairment (pre 26+/-32 versus post 22/-27%, not significant) or functional status score (pre 89+/-13 versus post 91+/-11, not significant). CONCLUSIONS: When the aortic valve is replaced promptly at symptom onset, despite improvement in resting le ft ventricular systolic performance, there is no evidence of improveme nt in exercise capacity or functional status.