Effects of aortic valve replacement on exercise duration and functional status in adults with valvular aortic stenosis
Munt, B.I.; Legget, M.E.; Healy, N.L.; Fujioka, M.; Schwaegler, R.; Otto, C.M.
Canadian Journal of Cardiology 13(4): 346-350
1997
ISSN/ISBN: 0828-282X PMID: 9141965 Document Number: 474969
OBJECTIVE: To evaluate the effect of aortic valve replacement on left ventricular function, functional status and exercise duration in an adult population with valvular aortic stenosis. DESIGN: Prospective study of initially asymptomatic patients with pre- and postvalve replacement echocardiography, functional status score and exercise data. SETTING: University-affiliated, tertiary care teaching hospital. PATIENTS: Valvular aortic stenosis patients referred from academic and private practice 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 rests. MAIN RESULTS: 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 ratio of early to atrial diastolic filling velocities (pre 1.2 +- 0.5 versus post 1.4 +- 0.8, not significant), exercise tolerance as assessed by 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 left ventricular systolic performance, there is no evidence of improvement in exercise capacity or functional status.