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PubMed1991

Pulmonary valve-moderator band distance and association with development of double-chambered right ventricle.

Double-chambered right ventricle (DCRV), a form of right ventricular outflow obstruction that sometimes accompanies a ventricular septal defect (VSD), is associated with superior and rightward displacement of the septal insertion of the moderator band. It was hypothesized that this superior displacement is present and identifiable by echocardiography in patients with a VSD even before right ventricular outflow tract obstruction develops. Eight patients who had a previous echocardiographic study showing a VSD alone were echocardiographically diagnosed as having DCRV. Their initial echocardiographic studies were reviewed, and superior displacement of the moderator band was quantified by measuring the distance between the pulmonary valve and moderator band, normalized to tricuspid anulus diameter. These measurements were compared with those from the initial studies of the following 3 other groups: (1) an age-matched group of 10 patients with no structural heart disease; (2) an age-matched group of 10 patients with a VSD who did not develop DCRV; and (3) a group (not age-matched) of 10 patients with VSD and DCRV in whom subpulmonary obstruction was present on the initial study. The 8 patients who eventually developed subpulmonary obstruction had significant superior displacement of the moderator band at the time of their initial echocardiogram compared with that of the 2 age-matched control groups (p less than 0.01). In contrast, there was no significant difference in moderator band displacement between these patients and the 10 with DCRV who already had right ventricular outflow obstruction at their initial study (p = not significant).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1986

Moderate-intensity physical activity and cardiovascular risk factors: the Stanford Five-City Project.

There is evidence that low to moderate levels of physical activity can reduce risk of cardiovascular disease, even though they do not produce substantial changes in cardiorespiratory function. In this study of a representative population sample of 5,930 adult men and women, participants in moderate-intensity activities, such as walking and climbing stairs, were compared with nonparticipants. Men and women who reported more moderate activities were less overweight than sedentary peers. Moderate activity was associated with more risk factor benefits in men than in women. The apparent health benefits of moderate-intensity physical activity have implications for public health education.

Adult↗

PubMed1995

Leukoencephalopathy in childhood hematopoietic neoplasm caused by moderate-dose methotrexate and prophylactic cranial radiotherapy--an MR analysis.

PURPOSE: The main purpose of this study was to determine influential factors related to minor leukoencephalopathy (LEP) caused by moderate-dose methotrexate (MTX) and prophylactic cranial radiotherapy (CRT) in childhood hematopoietic malignancies. We also compared the incidence of LEP following this treatment to that reported in the literature following treatment with high-dose MTX alone. METHODS AND MATERIALS: Thirty-eight pediatric patients of hematopoietic malignancies (37 acute lymphoblastic leukemias, 1 non-Hodgkin lymphoma) who were given CRT (18-24 Gy) as well as prophylactic intrathecal and per os MTX were studied for leukoencephalopathy by magnetic resonance (MR) imaging. All the patients were free from grave neuropsychiatric disturbances. The data were examined to elucidate the influential ones of five factors (patients' age, doses of intrathecal and per os MTX, dose of CRT, interval between treatment, and MR study) to develop LEP using multiple regression analysis. To compare the effect of moderate-dose MTX and prophylactic CRT on LEP to that of high-dose MTX alone, we conducted literature review. RESULTS: Seven out of 38 patients (18%) developed LEP. From multiple regression analysis and partial correlation coefficients, the age and CRT dose seemed influential in the subsequent development of LEP. The incidence of LEP following treatment with moderate-dose MTX and prophylactic CRT appears to be less than that reported in the literature following treatment with intravenous high-dose MTX. However, even moderate-dose MTX in combination with CRT can result in a significant incidence of MR-detectable LEP, particularly in children 6 years of age or younger receiving 24 Gy. CONCLUSION: Leukoencephalopathy was caused by moderate-dose MTX and prophylactic CRT in pediatric patients, probably less frequently than by high-dose MTX treatment alone. The influential factors were patient's age and CRT dose.

Adolescent↗

PubMed2005

Comparison of cardioprotective benefits of vigorous versus moderate intensity aerobic exercise.

Aerobic fitness, not merely physical activity, is associated with a reduced risk of cardiovascular disease. Vigorous intensity exercise has been shown to increase aerobic fitness more effectively than moderate intensity exercise, suggesting that the former may confer greater cardioprotective benefits. An electronic search of published studies using PubMed was conducted for 2 types of investigations, epidemiologic studies that evaluated the benefits of physical activity of varying intensity levels and clinical trials that trained individuals at different intensities of exercise while controlling for the total energy expenditure. A secondary search was conducted using the references from these studies. The epidemiologic studies consistently found a greater reduction in risk of cardiovascular disease with vigorous (typically > or =6 METs) than with moderate intensity physical activity and reported more favorable risk profiles for individuals engaged in vigorous, as opposed to moderate, intensity physical activity. Clinical trials generally reported greater improvements after vigorous (typically > or =60% aerobic capacity) compared with moderate intensity exercise for diastolic blood pressure, glucose control, and aerobic capacity, but reported no intensity effect on improvements in systolic blood pressure, lipid profile, or body fat loss. In conclusion, if the total energy expenditure of exercise is held constant, exercise performed at a vigorous intensity appears to convey greater cardioprotective benefits than exercise of a moderate intensity.

Blood Glucose↗

PubMed2005

Aortic valve replacement in patients with mild or moderate aortic stenosis and coronary bypass surgery.

PURPOSE: To assess whether there is survival benefit for patients with mild or moderate aortic stenosis if they undergo aortic valve replacement at the time of coronary artery bypass surgery. METHODS: From 1985 to 1995 we evaluated all patients at our institution who underwent coronary artery bypass surgery and who had the echocardiographic diagnosis of mild (mean gradient <0 mm Hg and/or valve area >1.5 cm(2)) or moderate (mean gradient > or =30 and < or =40 mm Hg and/or valve area >1.0 < or =1.5 cm(2)) aortic stenosis. Using propensity analysis, survival was compared between 129 patients who underwent coronary artery bypass surgery alone and 78 patients who underwent concomitant coronary artery bypass surgery and aortic valve replacement. RESULTS: Perioperative mortality was similar among patients who underwent coronary artery bypass surgery alone compared with patients who underwent concomitant coronary artery bypass surgery and aortic valve replacement. By Kaplan-Meier analysis, 1-year and 8-year survival were better at 90% and 55% for patients who underwent concomitant coronary artery bypass surgery and aortic valve replacement compared with 85% and 39% for patients who underwent coronary artery bypass surgery alone (P <0.001). This benefit was limited to patients with moderate aortic stenosis (propensity-adjusted relative risk = 0.43; 95% confidence interval: 0.20 to 0.96; P = 0.04). CONCLUSION: Concomitant aortic valve replacement at the time of coronary artery bypass surgery for mild or moderate aortic stenosis appears to convey a survival advantage for patients with moderate aortic stenosis but not for those with mild aortic stenosis.

Aged↗

PubMed2006

Moderate-intensity exercise reduces the incidence of colds among postmenopausal women.

PURPOSE: Our aim was to assess the effect of a moderate-intensity, year-long exercise program on the risk of colds and other upper respiratory tract infections in postmenopausal women. SUBJECTS: A total of 115 overweight and obese, sedentary, postmenopausal women in the Seattle area participated. METHODS: Participants were randomly assigned to the moderate-intensity exercise group or the control group. The intervention consisted of 45 minutes of moderate-intensity exercise 5 days per week for 12 months. Control participants attended once-weekly, 45-minute stretching sessions. Questionnaires asking about upper respiratory tract infections in the previous 3 months were administered quarterly during the course of the year-long trial. Poisson regression was used to estimate the effect of exercise on colds and other upper respiratory tract infections. RESULTS: Over 12 months, the risk of colds decreased in exercisers relative to stretchers (P = .02): In the final 3 months of the study, the risk of colds in stretchers was more than threefold that of exercisers (P = .03). Risk of upper respiratory tract infections overall did not differ (P = .16), yet may have been biased by differential proportions of influenza vaccinations in the intervention and control groups. CONCLUSIONS: This study suggests that 1 year of moderate-intensity exercise training can reduce the incidence of colds among postmenopausal women. These findings are of public health relevance and add a new facet to the growing literature on the health benefits of moderate exercise.

Aged↗

PubMed2006

Psychometric properties of a modified Wolf Motor Function test for people with mild and moderate upper-extremity hemiparesis.

OBJECTIVE: To test the necessity of videotaping, test-retest reliability, and item stability and validity of a modified Wolf Motor Function Test (WMFT) for people with mild and moderate chronic upper-extremity (UE) hemiparesis caused by stroke. DESIGN: Raters of videotape versus direct observation; test-retest reliability over 3 observations, item stability, and criterion validity with upper-extremity Fugl-Meyer Assessment (FMA) in the mildly and moderately impaired groups. SETTING: Academic research center. PARTICIPANTS: Sixty-six subjects with chronic UE hemiparesis who participated in a large intervention study. Subjects were classified into mild and moderate groups for additional analyses. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Mean and median times of task completion, functional ability, and strength (weight to box) measures of the WMFT. FMA scores for validity assessment. RESULTS: In a subgroup of 10 subjects, the intraclass correlation coefficient (ICC) for videotape versus direct observation ranged from .96 to .99. For the whole group, test-retest reliability using ICC2,1 ranged from .97 to .99; stability of the test showed that administration 1 differed from administrations 2 and 3 but administrations 2 and 3 did not differ; item analysis showed that 4 of 17 items changed across time, and validity, using a correlation with UE FMA, ranged from .86 to .89. Separate mild- and moderate-group analyses were similar to whole-group results. CONCLUSIONS: Videotaping the modified WMFT was not necessary for accurate scoring. The modified WMFT is reliable and valid as an outcome measure for people with chronic moderate and mild UE hemiparesis and is stable, but 1 repeat testing is recommended when practical.

Adult↗

PubMed2006

Does the presence of preoperative mild or moderate coronary artery disease affect the outcomes of lung transplantation?

BACKGROUND: Significant coronary artery disease (CAD) is an exclusion criterion for lung transplantation at most centers. However, the impact of preoperative noncritical CAD (single or multivessel mild <30% or moderate 30% to 50% stenosis) on the outcomes of lung transplantation is unknown. METHODS: A retrospective review of 268 adult patients who underwent lung transplantation between June 1998 and June 2003 at Barnes-Jewish Hospital, a tertiary care center affiliated with Washington University School of Medicine, was performed. RESULTS: Two hundred ten patients had coronary angiography performed as part of their pretransplantation evaluation. Among these patients, 177 patients had no CAD, and 33 patients (mild, 16; moderate, 17) had noncritical CAD. Patients with noncritical CAD were older (59 versus 55 years, p < 0.001) and had a higher prevalence of diabetes (24% versus 9%, p = 0.014) and systemic hypertension (58% versus 36%, p = 0.004) than patients without CAD. There was no significant difference in the underlying lung disease, other comorbidities, type of lung transplantation performed, early postoperative complications, and hospital or late mortality between recipients with or without CAD. Among the patients with noncritical CAD, there was no hospital mortality and no late cardiac mortality. Three recipients with preoperative moderate CAD developed late ischemic cardiac events, and revascularization was performed in 2 of these recipients. Long-term survival was similar among recipients with or without preoperative CAD. CONCLUSIONS: Preoperative noncritical (mild or moderate) CAD was not associated with increased perioperative morbidity or mortality, and it did not adversely affect short-term or long-term survival. Late ischemic events developed in 18% of the recipients with moderate CAD disease with no effect on mortality.

Adult↗

PubMed2004

Frontal EEG asymmetry as a moderator and mediator of emotion.

Frontal EEG asymmetry appears to serve as (1) an individual difference variable related to emotional responding and emotional disorders, and (2) a state-dependent concomitant of emotional responding. Such findings, highlighted in this review, suggest that frontal EEG asymmetry may serve as both a moderator and a mediator of emotion- and motivation-related constructs. Unequivocal evidence supporting frontal EEG asymmetry as a moderator and/or mediator of emotion is lacking, as insufficient attention has been given to analyzing the frontal EEG asymmetries in terms of moderators and mediators. The present report reviews the frontal EEG asymmetry literature from the framework of moderators and mediators, and overviews data analytic strategies that would support claims of moderation and mediation.

Electroencephalography↗

PubMed2004

Influence of moderate and profound hyperventilation on cerebral blood flow, oxygenation and metabolism.

OBJECTIVE: The aim of the present study was to examine the impact of moderate and profound hyperventilation on regional cerebral blood flow (rCBF), oxygenation and metabolism. MATERIALS AND METHODS: Twelve anesthetized pigs were subjected to moderate (mHV) and profound (pHV) hyperventilation (target arterial pO(2): 30 and 20 mmHg, respectively) for 30 min each, after baseline normoventilation (BL) for 1 h. Local cerebral extracellular fluid (ECF) concentrations of glucose, lactate, pyruvate and glutamate as well as brain tissue oxygenation (p(ti)O(2)) were monitored using microdialysis and a Licox oxygen sensor, respectively. In nine pigs, regional cerebral blood flow (rCBF) was also continuously measured via a thermal diffusion system. RESULTS: Both moderate and profound hyperventilation resulted in a significant decrease in rCBF (BL: 37.9+/-4.3 ml/100 g/min; mHV: 29.4+/-3.6 ml/100 g/min; pHV: 23.6+/-4.7 ml/100 g/min; p<0.05) and p(ti)O(2) (BL: 22.7+/-4.1 mmHg; mHV: 18.9+/-4.9 mmHg; pHV: 13.0+/-2.2 mmHg; p<0.05). A p(ti)O(2) decrease below the critical threshold of 10 mmHg was induced in three animals by moderate hyperventilation and in five animals by profound hyperventilation. Furthermore, significant increases in lactate (BL: 1.06+/-0.18 mmol/l; mHV: 1.36+/-0.20 mmol/l; pHV: 1.67+/-0.17 mmol/l; p<0.005), pyruvate (BL: 46.4+/-7.8 micromol/l; mHV: 58.0+/-10.3 micromol/l; pHV: 66.1+/-12.7 micromol/l; p<0.05), and lactate/glucose ratio were observed during hyperventilation. (Data are presented as mean+/-S.E.M.) CONCLUSIONS: Both moderate and profound hyperventilation may result in insufficient regional oxygen supply and anaerobic metabolism, even in the uninjured brain. Therefore, the use of hyperventilation cannot be considered as a safe procedure and should either be avoided or used with extreme caution.

Animals↗

PubMed2005

Low-to-moderate alcohol intake and health status in heart failure patients.

BACKGROUND: Although heart failure (HF) guidelines recommend alcohol abstinence, existing evidence indicates that alcohol may not worsen survival and no data about associations between alcohol and health status (patients' symptoms, function, and quality of life) exist. METHODS AND RESULTS: Alcohol use was quantified in 420 HF outpatients. The associations between moderate alcohol intake (1 to 60 drinks/month) and health status were assessed by comparing baseline and 1-year Kansas City Cardiomyopathy Questionnaire (KCCQ) and Short Form-12 (SF-12) scores between moderate and nondrinkers. No differences in baseline KCCQ or SF-12 scores between abstainers (n = 245) and moderate drinkers (n = 175) were observed (KCCQ 60.5 +/- 24 versus 61.9 +/- 23.5, P = .55; SF-12 Physical Component Score (PCS) 33.6 +/- 11.2 versus 35.3 +/- 10.2, P = .14; and SF-12 Mental Component Score (MCS) 49.1 +/- 11.1 versus 49.4 +/- 11.4, P = .78). Abstainers and drinkers also had similar 1-year KCCQ scores (65.8 +/- 24.5 versus 69.3 +/- 24.1, P = .23), mortality (10.5% versus 11.6%, P = .72) and HF hospitalizations (18.0% versus 15.4%, P = .51). Multivariable analyses controlling for baseline differences also revealed similar outcomes between abstainers and drinkers-1-year KCCQ change = 4.3 +/- 1.8 versus 5.2 +/- 2.5; P = .75), mortality (OR = 1.33, 95% CI 0.67-2.64), or HF hospitalization (OR = 1.13, 95% CI 0.60-2.11). CONCLUSION: No relationships between moderate alcohol consumption and health status or 1-year outcomes were identified in this multicenter observational study. These data do not support the need for complete alcohol abstinence for all HF patients among those who drink in moderation.

Alcohol Drinking↗

PubMed2005

Stressors and child and adolescent psychopathology: evidence of moderating and mediating effects.

This paper reviews studies that have tested for moderators or mediators of the relation between stressors and child and adolescent psychopathology. Many studies have tested for moderation, but results of research studying moderators have been inconclusive. There have been few theory-based studies and there have been few consistent findings. Far fewer studies have tested for mediation effects, but these studies have generally been theory-driven, have more often built upon one another in an incremental fashion, and have yielded consistent results. In particular, there is substantial evidence for the mediating role of family relationship in the relation between stressors and child and adolescent psychological symptoms. Future studies should integrate moderator and mediator research by testing for specific mediators in relation to particular moderating contexts, so that we can better understand the complex ways in which stressful life experiences affect the well-being of children and adolescents.

Adolescent↗

PubMed2004

Mild and moderate aortic stenosis. Natural history and risk stratification by echocardiography.

AIMS: To define the natural history and predictors of outcome in mild and moderate aortic stenosis (AS). METHODS AND RESULTS: One hundred and seventy-six consecutive asymptomatic patients (73 women, age 58+/-19 years) with mild to moderate AS (jet velocity 2.5 to 3.9m/s) were followed for 48+/-19 months. Haemodynamic progression and clinical outcome was analysed. Event-free survival with end-points defined as death (n=34) or aortic valve surgery (n=33), was 95+/-2%, 75+/-3% and 60+/-5% at 1, 3 and 5 years, respectively. Both, cardiac and non-cardiac mortality were significantly increased, resulting in a 1.8 times higher mortality than expected (P<0.005). By multivariate analysis, moderate to severe aortic valve calcification, coronary artery disease (CAD) and peak jet velocity were independent predictors of outcome. Event-free survival for patients with moderate or severe valve calcification was 92+/-4%, 61+/-7% and 42+/-7% at 1, 3 and 5 years versus 100%, 90+/-4% and 82+/-5% for patients with no or mild calcification. Patients with calcified aortic valves, CAD or with an event had a significantly faster haemodynamic progression. Of 129 patients with a follow-up echocardiographic exam, 59 (46%) developed severe stenosis during follow-up. CONCLUSION: Outcome of mild and moderate AS is worse than commonly assumed. Rapid progression and excess mortality have to be considered. Significant valve calcification, CAD and rapid progression of aortic jet velocity indicate poor outcome. Patients with these characteristics may require closer follow-up than generally assumed.

Aged↗

PubMed2005

Pharmacological dissociation of moderate and high contextual fear as assessed by freezing behavior and fear-potentiated startle.

The amplitude of the whole-body acoustic startle response is reliably enhanced when elicited in the presence of foreground signals, such as light, previously paired with footshocks. It has been shown that this enhancement is evident by moderate fear levels, but is less affected by high fear levels. Potentiation of the acoustic startle reflex has also been reported in the presence of background cues previously associated with footshocks. However, the effects of anxiolytic drugs on different levels of fear elicited by moderate and intense contextual fear conditioning associated with startle reflex have not been examined yet. To approach this issue, we examined the effects of the anxiolytic, midazolam, on two intensities of contextual fear; freezing behavior and the startle response to loud noise. First, we compared the magnitude of the freezing behavior and the startle amplitude during the testing sessions in groups of rats submitted to fear conditioning using 0.3 and 0.6 mA as unconditioned stimuli (10 stimuli of 1 s each, intertrial interval from 60 to 180 s). Afterwards, the effects of midazolam (0.5 and 1.0 mg/kg) were assessed in these two conditions. Rats showed a potentiated startle reflex and a significant freezing behavior to moderate fear conditioning, which were both attenuated by midazolam. Higher levels of fear conditioning caused more intense freezing behavior without enhancing the startle reflex. Whereas midazolam reduced this freezing response, the startle response was unaffected. These results are indicative that anxiolytic-sensitive freezing and fear-potentiated startle are triggered by moderate contextual fear conditioning, while contextual conditioning with the use of high footshocks causes a distinct pattern of behavioral responses, which is only partially affected by midazolam. Due to the differential sensitivity to midazolam of these two patterns of startle responses generated as a function of the intensity of contextual fear conditioning, it is proposed that they represent moderate and intense aversive states that may be related to anxiety or panic/phobic conditions, respectively.

Acoustic Stimulation↗

PubMed2005

Evidence of cardiovascular protection by moderate alcohol: role of nitric oxide.

Epidemiological evidence indicates that moderate alcohol consumption reduces the incidence of heart disease. Endothelial nitric oxide synthase (eNOS) is a key regulator of vascular homeostasis and myocardial functions through the controlled production of nitric oxide (*NO). These studies were conducted to determine if the apparent alcohol-associated cardioprotection is mediated, in part, through modulation of the eNOS protein and activity in the cardiovascular system. Rats were fed alcohol and eNOS protein and *NO production were evaluated at the end of 8 weeks. Myocardial and vascular function was assessed ex vivo in a subset of animals. Moderate alcohol improved postischemic myocardial systolic and diastolic function and attenuated the postischemic reduction in coronary vascular resistance. Moderate alcohol also enhanced maximum vascular relaxation by 26 +/- 0.2% and increased plasma *NO production concomitant with a greater than 2.5-fold increase in eNOS protein. Higher levels of alcohol impaired maximum vascular relaxation by 22 +/- 0.1%. These results suggest that moderate alcohol improves postischemic myocardial functions and increases *NO production by vascular endothelium. An increase in *NO may explain, at least in part, the cardioprotective benefits of moderate alcohol consumption.

Animals↗

PubMed2006

Moderate versus light pressure massage therapy leads to greater weight gain in preterm infants.

Sixty-eight preterm infants (M GA=30 weeks) were randomly assigned to a moderate or to a light pressure massage therapy group to receive 15 massages three times per day for 5 days. Behavior state, stress behaviors and heart rate were recorded for 15min before and during the first 15-min therapy session. Weight gain was recorded over the 5-day therapy period. The moderate versus light pressure massage group gained significantly more weight per day. During the behavior observations the moderate versus light pressure massage group showed significantly lower increases from the pre-session to the session recording on: (1) active sleep; (2) fussing; (3) crying; (4) movement; and (5) stress behavior (hiccupping). They also showed a smaller decrease in deep sleep, a greater decrease in heart rate and a greater increase in vagal tone. Thus, the moderate pressure massage therapy group appeared to be more relaxed and less aroused than the light pressure massage group which may have contributed to the greater weight gain of the moderate pressure massage therapy group.

Body Weight↗

PubMed2004

The protective effect of moderate hypothermia during intestinal ischemia-reperfusion is associated with modification of hepatic transcription factor activation.

BACKGROUND/PURPOSE: Moderate hypothermia throughout intestinal ischemia-reperfusion (IIR) injury reduces multiple organ dysfunction. Heat shock proteins (HSPs) have been shown to be protective against ischemia-reperfusion injury, and STAT (Signal Transducers and Activators of Transcription) proteins are pivotal determinants of the cellular response to reperfusion injury. The aim of this study is to investigate the mechanism of hypothermic protection during IIR. METHODS: Adult rats underwent intestinal ischemia-reperfusion (IIR), 60-minute ischemia and 60-minute reperfusion, or sham (120 minutes) at either normothermia or moderate hypothermia. Four groups of animals were studied: (1) normothermic sham (NS), (2) normothermic IIR (NIIR), (3) hypothermic sham (HS), and (4) hypothermic IIR (HIIR). Western blotting measured heat shock protein expression, phosphorylated (p-) and total (T-) hepatic STAT-1 and STAT-3. RESULTS: There were no differences in expression of HSPs 27, 47, 60, i70, c70, or 90 between any of the experimental groups. NIIR caused a significant increase in p-STAT-1 compared with normothermic sham (P <.05) and a highly significant increase in p-STAT-3 (P <.001), both these increases were completely abolished by moderate hypothermia (P <.01 v NIIR.) CONCLUSIONS: The protective effect of moderate hypothermia on liver is not mediated by HSP expression at this time-point. Hypothermia may act by decreasing hepatic STAT activation, supporting the potential therapeutic role of moderate hypothermia. Modulation of STAT activation may also provide novel therapeutic targets.

Animals↗

PubMed2005

Preoperative moderate to severe diastolic dysfunction: a novel Doppler echocardiographic long-term prognostic factor in patients with severe aortic stenosis.

OBJECTIVE: We studied long-term outcomes in severe aortic stenosis and the importance of prosthesis type (mechanical vs biologic) and size, preoperative left ventricular ejection fraction, diastolic function, and left ventricular mass. METHODS: Patients undergoing valve replacement from 1991 to 1993 (n = 399, 45% women) were included. The diastolic function was evaluated by integrating mitral and pulmonary venous flow data with Doppler echocardiography. The patients were classified as having either normal diastolic function to mild diastolic dysfunction or moderate to severe diastolic dysfunction. Left ventricular ejection fraction and the diastolic function category were incorporated together with age, sex, and time since operation into a Poisson regression model with death as the end point. Prosthesis type and size and left ventricular mass were also investigated. RESULTS: The age (mean +/- SD) was 71 +/- 9 years, and the overall survival after 12 years was 50%. Although markedly reduced during the initial 6-month period, mortality risk subsequently increased more than could be explained by age (hazard ratio of 1-year difference = 1.12, P = .0005). The moderate to severe diastolic dysfunction pattern independently predicted late mortality (hazard ratio = 1.72, P = .0038), whereas left ventricular ejection fraction did not (hazard ratio = 0.99, P = .18). The prognostic importance of moderate to severe diastolic dysfunction did not diminish with time; on the contrary, it tended to increase. Mortality after 12 years was not predicted by left ventricular mass (P = .66), prosthesis type (P = .57), or prosthesis size (P = .58). CONCLUSION: This study reveals that moderate to severe diastolic dysfunction in patients with aortic stenosis is an independent predictor of late mortality after valve replacement and that its importance does not decrease with time. Our findings may suggest that moderate to severe diastolic dysfunction implies nonreversible myocardial changes that negatively affect survival.

Age Factors↗