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Effects of aortic valve replacement on exercise duration and functional status in adults with valvular aortic
B I Munt1, M E Legget, N L Healy
1Department of Medicine, University of Washington, Seattle 98195, USA.
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 cm2).
Interventions:
Annual Doppler echocardiography, functional status questionnaires and, if possible, Bruce protocol maximal exercise tolerance tests.
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.