Predictive value of exercise stress echocardiography in asymptomatic patients with severe aortic regurgitation and preserved left ventricular systolic function without LV dilatation

AbstractThe management of asymptomatic patients with severe aortic regurgitation (AR) and preserved left ventricular (LV) systolic function remains controversial. We evaluated the predictive value of exercise stress echocardiography (ESE) in asymptomatic severe AR with preserved LV systolic function for identifying high risk patients who might benefit from early referral for surgery. Symptom-limited treadmill ESE was performed in 67 asymptomatic patients with severe AR (effective regurgitant orifice area>  30 mm2, regurgitant volume>  60 ml) and preserved LV systolic function without LV dilatation [ejection fraction (EF) ≥ 50% and LV end-systolic diameter ≤ 50 mm]. A post-exercise EF increase of>  4% was defined as presence of contractile reserve (CR). The primary outcome was defined as the composite of symptoms development, deterioration in LV function (EF <  50% in echocardiography) and aortic valve replacement (AVR) at follow-up. Operations performed within 60 days of ESE were excluded. Twenty-eight patients were CR (+) and 39 patients were CR (−). Compared with the CR (+) group, the CR (−) group was older (52.0 ± 14.0 years vs. 43.8 ±  10.6 years, p = 0.011) and had higher Ln N-terminal natriuretic peptide (NT-proBNP) [5.2 (4.5–5.7) vs. 4.1 (3.7–5.1), p = 0.001]. The CR (−) group showed lower exercise time than the CR (+) group (576 ± 159 s vs. 671 ± 108 s, p = 0.008). Otherwise, there were no...
Source: The International Journal of Cardiovascular Imaging - Category: Radiology Source Type: research