R G Schwaegler | PubMed Health

PubMed1997

Prospective study of asymptomatic valvular aortic stenosis. Clinical, echocardiographic, and exercise predictors of outcome.

BACKGROUND: Only limited data on the rate of hemodynamic progression and predictors of outcome in asymptomatic patients with valvular aortic stenosis (AS) are available. METHODS AND RESULTS: In 123 adults (mean age, 63 +/- 16 years) with asymptomatic AS, annual clinical, echocardiographic, and exercise data were obtained prospectively (mean follow-up of 2.5 +/- 1.4 years). Aortic jet velocity increased by 0.32 +/- 0.34 m/s per year and mean gradient by 7 +/- 7 mm Hg per year; valve area decreased by 0.12 +/- 0.19 cm2 per year. Kaplan-Meier event-free survival, with end points defined as death (n = 8) or aortic valve surgery (n = 48), was 93 +/- 5% at 1 year, 62 +/- 8% at 3 years, and 26 +/- 10% at 5 years. Univariate predictors of outcome included baseline jet velocity, mean gradient, valve area, and the rate of increase in jet velocity (all P < or = .001) but not age, sex, or cause of AS. Those with an end point had a smaller exercise increase in valve area, blood pressure, and cardiac output and a greater exercise decrease in stroke volume. Multivariate predictors of outcome were jet velocity at baseline (P < .0001), the rate of change in jet velocity (P < .0001), and functional status score (P = .002). The likelihood of remaining alive without valve replacement at 2 years was only 21 +/- 18% for a jet velocity at entry > 4.0 m/s, compared with 66 +/- 13% for a velocity of 3.0 to 4.0 m/s and 84 +/- 16% for a jet velocity < 3.0 m/s (P < .0001). CONCLUSIONS: In adults with asymptomatic AS, the rate of hemodynamic progression and clinical outcome are predicted by jet velocity, the rate of change in jet velocity, and functional status.

Aged↗

PubMed1996

Gender differences in left ventricular function at rest and with exercise in asymptomatic aortic stenosis.

In 29 women and 53 men with asymptomatic aortic stenosis, two-dimensional (2-D) and Doppler echocardiography were performed at rest and immediately after treadmill exercise testing to examine gender differences in left ventricular geometry, systolic and diastolic function, functional status, and exercise capacity. Aortic stenosis severity was similar between men and women. Women reported more functional impairment than men (88% +/- 14% vs 95% +/- 7%; p = 0.02). When indexed to body surface area, women had a smaller end-diastolic volume (39 +/- 14 vs 50 +/- 15 ml/m2; p = 0.002), end-systolic volume (13 +/- 6 ml/m2 vs 18 +/- 9 ml/m2; p = 0.01) and left ventricular mass (73 +/- 26 gm/m2 vs 84 +/- 21 gm/m2; p = 0.05), but a higher relative wall thickness in systole (1.5 +/- 0.4 cm vs 1.3 +/- 0.4 cm; p = 0.05), and fractional shortening (43% +/- 7% vs 39% +/- 10%; p = 0.03). Women had higher early and late transmitral velocities than did men (early, 92 +/- 24 cm/sec vs 79 +/- 29 cm/sec; p = 0.05; late, 97 +/- 30 cm/sec vs 68 +/- 23 cm/sec; p < 0.0001), a higher time-velocity integral in early diastole (18.2 +/- 4.8 cm vs 15.1 +/- 4.3 cm; p = 0.006), a significantly shorter exercise duration (4.5 +/- 4.1 minutes vs 8.0 +/- 3.9 minutes; p < 0.0001), a greater degree of functional aerobic impairment (25% +/- 48% vs 2% +/- 33%; p = 0.02), and a smaller increase in cardiac output with exercise (5.4 +/- 3.5 L/min vs 8.0 +/- 4.3 L/min; p = 0.01), in spite of similar peak heart rate and blood pressure responses. In these asymptomatic subjects with aortic stenosis, women had smaller, relatively hypercontractile ventricles, a different diastolic filling profile, more exercise limitation, and poorer functional capacity. These findings demonstrate the importance of gender in the response of the left ventricle to chronic pressure overload.

Adult↗