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Exercise Doppler echocardiography in patients with mitral prosthetic valves
S A Reisner1, G S Lichtenberg, J R Shapiro
1Department of Medicine, University of Rochester, NY.
American Heart Journal
|October 1, 1989
Summary
Submaximal exercise with Doppler echocardiography effectively assesses mechanical mitral valve function. Starr-Edwards valves showed higher exercise-induced gradients than Björk-Shiley valves, highlighting exercise
Area of Science:
- Cardiology
- Biomedical Engineering
- Diagnostic Imaging
Background:
- Mechanical mitral valves, including Björk-Shiley (BS) and Starr-Edwards (SE) prostheses, are used to manage mitral valve disease.
- Assessing the hemodynamic function of these valves, especially during physiological stress, is crucial for patient management.
- Exercise echocardiography offers a potential method to evaluate valve performance under increased demand.
Purpose of the Study:
- To evaluate the hemodynamic response of mechanical mitral prostheses (BS and SE) to submaximal supine exercise using Doppler echocardiography.
- To compare the exercise-induced changes in transmitral gradients between BS and SE valve types.
- To determine the utility of exercise Doppler echocardiography in assessing mechanical valve function.
Main Methods:
- Seventeen patients with mitral prostheses (11 BS, 6 SE) underwent submaximal supine exercise.
- Doppler echocardiography was used to measure transmitral gradients at rest and during peak exercise.
- Heart rate versus transmitral gradient curves were generated during recovery.
Main Results:
- Both BS and SE valves showed increased transmitral gradients with exercise.
- Starr-Edwards valves exhibited significantly higher peak and mean gradients at peak exercise compared to Björk-Shiley valves.
- The increase in peak gradient from rest to exercise was also significantly greater for SE valves.
- Doppler echocardiography during exercise was feasible in most patients and revealed hemodynamic differences, particularly the occlusive nature of SE prostheses.
Conclusions:
- Submaximal supine exercise combined with Doppler echocardiography is a feasible method for assessing mechanical mitral valve hemodynamics.
- Exercise unmasks important hemodynamic characteristics, such as the occlusive nature of Starr-Edwards prostheses, which may not be apparent at rest.
- This technique provides valuable information, especially for patients with borderline resting measurements, aiding in the evaluation of valve function.