Bi. Munt et al., EFFECTS OF AORTIC-VALVE REPLACEMENT ON EXERCISE DURATION AND FUNCTIONAL STATUS IN ADULTS WITH VALVULAR AORTIC-STENOSIS, Canadian journal of cardiology, 13(4), 1997, pp. 346-350
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.