Contractile reserve determined on exercise echocardiography in patients with severe aortic regurgitation

Sung Ji Park, Maurice E Sarano, Jung Eun Song, Yung Joo Lee, Mi Ran Ha, Sung A. Chang, Jin Oh Choi, Sang Chol Lee, Seung Woo Park, Jae Kuen Oh

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Background: The aim of this study was to assess contractile reserve (CR) in patients with severe aortic regurgitation (AR), and potential clinical applications of CR in minimally symptomatic patients. Methods and Results: Symptom-limited treadmill exercise echocardiography was performed in 58 asymptomatic or mildly symptomatic patients with chronic severe AR (male 69%, 50±14 years). Patients with increased ejection fraction (EF) after exercise were denoted as having CR (+) and those without increased EF were categorized as CR (-). CR (+) was found in 31 and CR (-) in 27 patients. Compared with CR (+), the CR (-) group had lower EF, larger effective regurgitant orifice, regurgitant volume, left ventricular (LV) end-diastolic dimension, LV end-systolic dimension (LVESD), and LV mass index. On multiple logistic regression analysis LVESD index (LVESDI; odds ratio -0.354, P<0.0001) was an independent predictor of CR. One-third of patients with LVESD >50 mm, however, were found to be CR (+), while one-third of patients with smaller LVESD were CR (-). Conclusions: Although CR is best related to baseline resting LVESDI, one-third of patients were found to have discordance between the presence of CR and the LV dimension recommended for aortic valve replacement (AVR) in minimally symptomatic patients with severe AR, suggesting that exercise test may be able to further stratify the current guideline for AVR.

Original languageEnglish (US)
Pages (from-to)2390-2398
Number of pages9
JournalCirculation Journal
Volume77
Issue number9
DOIs
StatePublished - 2013

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Aortic Valve Insufficiency
Echocardiography
Exercise
Aortic Valve
Exercise Test
Stroke Volume
Logistic Models
Odds Ratio
Regression Analysis
Guidelines

Keywords

  • Aortic regurgitation
  • Contractile reserve
  • Exercise stress echocardiography

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Contractile reserve determined on exercise echocardiography in patients with severe aortic regurgitation. / Park, Sung Ji; Sarano, Maurice E; Song, Jung Eun; Lee, Yung Joo; Ha, Mi Ran; Chang, Sung A.; Choi, Jin Oh; Lee, Sang Chol; Park, Seung Woo; Oh, Jae Kuen.

In: Circulation Journal, Vol. 77, No. 9, 2013, p. 2390-2398.

Research output: Contribution to journalArticle

Park, Sung Ji ; Sarano, Maurice E ; Song, Jung Eun ; Lee, Yung Joo ; Ha, Mi Ran ; Chang, Sung A. ; Choi, Jin Oh ; Lee, Sang Chol ; Park, Seung Woo ; Oh, Jae Kuen. / Contractile reserve determined on exercise echocardiography in patients with severe aortic regurgitation. In: Circulation Journal. 2013 ; Vol. 77, No. 9. pp. 2390-2398.
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AU - Choi, Jin Oh

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N2 - Background: The aim of this study was to assess contractile reserve (CR) in patients with severe aortic regurgitation (AR), and potential clinical applications of CR in minimally symptomatic patients. Methods and Results: Symptom-limited treadmill exercise echocardiography was performed in 58 asymptomatic or mildly symptomatic patients with chronic severe AR (male 69%, 50±14 years). Patients with increased ejection fraction (EF) after exercise were denoted as having CR (+) and those without increased EF were categorized as CR (-). CR (+) was found in 31 and CR (-) in 27 patients. Compared with CR (+), the CR (-) group had lower EF, larger effective regurgitant orifice, regurgitant volume, left ventricular (LV) end-diastolic dimension, LV end-systolic dimension (LVESD), and LV mass index. On multiple logistic regression analysis LVESD index (LVESDI; odds ratio -0.354, P<0.0001) was an independent predictor of CR. One-third of patients with LVESD >50 mm, however, were found to be CR (+), while one-third of patients with smaller LVESD were CR (-). Conclusions: Although CR is best related to baseline resting LVESDI, one-third of patients were found to have discordance between the presence of CR and the LV dimension recommended for aortic valve replacement (AVR) in minimally symptomatic patients with severe AR, suggesting that exercise test may be able to further stratify the current guideline for AVR.

AB - Background: The aim of this study was to assess contractile reserve (CR) in patients with severe aortic regurgitation (AR), and potential clinical applications of CR in minimally symptomatic patients. Methods and Results: Symptom-limited treadmill exercise echocardiography was performed in 58 asymptomatic or mildly symptomatic patients with chronic severe AR (male 69%, 50±14 years). Patients with increased ejection fraction (EF) after exercise were denoted as having CR (+) and those without increased EF were categorized as CR (-). CR (+) was found in 31 and CR (-) in 27 patients. Compared with CR (+), the CR (-) group had lower EF, larger effective regurgitant orifice, regurgitant volume, left ventricular (LV) end-diastolic dimension, LV end-systolic dimension (LVESD), and LV mass index. On multiple logistic regression analysis LVESD index (LVESDI; odds ratio -0.354, P<0.0001) was an independent predictor of CR. One-third of patients with LVESD >50 mm, however, were found to be CR (+), while one-third of patients with smaller LVESD were CR (-). Conclusions: Although CR is best related to baseline resting LVESDI, one-third of patients were found to have discordance between the presence of CR and the LV dimension recommended for aortic valve replacement (AVR) in minimally symptomatic patients with severe AR, suggesting that exercise test may be able to further stratify the current guideline for AVR.

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