ISSN 2996-8215
International Journal of Cardiology | Vol. 1, No. 11, November 2010 | pp. 81–88
DOI: 10.46882/2010/IJC/000020
Original Research Article
Long-Term Prognostic Value of Exercise Stress Echocardiography in Patients with Asymptomatic Severe Aortic Regurgitation
Sven Lindstrom¹, Ingrid Johansson¹, Anders Nielsen²
¹Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
²Department of Clinical Physiology, Aarhus University Hospital, Aarhus, Denmark
Abstract:
Managing asymptomatic patients with severe aortic regurgitation (AR) and preserved left ventricular (LV) ejection fraction is challenging. Exercise stress echocardiography may unmask latent LV myocardial dysfunction and help time surgical interventions. This study investigated the long-term prognostic value of exercise echocardiography parameters in asymptomatic severe AR. We prospectively followed 120 asymptomatic patients with severe AR and resting LVEF greater than 50%. All patients underwent symptom-limited treadmill exercise echocardiography at baseline. The development of an exercise-induced decrease or lack of increase in LVEF (defined as an change in LVEF less than 5%), along with limited contractile reserve, was evaluated. The primary clinical endpoint was a composite of the development of cardiac symptoms, new resting LV dysfunction (LVEF less than 50%), or cardiac mortality. Over a median follow-up period of 5.4 years, 42 patients (35.0%) reached the primary endpoint and underwent aortic valve surgery. A lack of contractile reserve during exercise (delta LVEF less than 5%) was observed in 38 patients (31.7%) at baseline. Multivariable Cox analysis demonstrated that an exercise-induced change in LVEF less than 5% was strongly and independently associated with the primary endpoint (hazard ratio: 2.85, 95% CI: 1.64–4.95, p < 0.001). Pre-exercise global longitudinal strain was also predictive. Exercise stress echocardiography provides substantial prognostic benefit in asymptomatic severe aortic regurgitation, showing that a lack of contractile reserve during exertion strongly predicts future clinical symptom development or explicit myocardial failure.
Keywords: Aortic regurgitation, Exercise stress echocardiography, Contractile reserve, Left ventricular function, Prognosis, Aortic valve surgery
Received: August 04, 2010; Revised: September 19, 2010; Accepted: October 12, 2010; Published: November 18, 2010
Citation: International Journal of Cardiology, 2010, Vol. 1, No. 11, pp. 81–88, DOI: 10.46882/2010/IJC/000020