title: Usefulness of mean aortic valve gradient and left ventricular diastolic filling pattern for distinguishing symptomatic from asymptomatic patients.
abstract: Consecutive, symptomatic (n = 15) and asymptomatic (n = 25) men with aortic stenosis (valve area < 1.2 cm2) and no clinical evidence of myocardial ischemia underwent radionuclide angiography at rest and during supine bicycle ergometry. Ejection fraction, diastolic filling pattern and aortic valve area/gradient were measured on enrollment and when patients became symptomatic (n = 10) or underwent valve replacement (n = 22) during a 2-year follow-up period. Both groups had similar heart rate, blood pressure and ejection fractions, but mean aortic gradients were higher in symptomatic (53 +/- 4 mm Hg) than asymptomatic (37 +/- 2 mm Hg) subjects p < 0.01. Functional limitation evoked by exercise was prevalent even in the asymptomatic group but symptomatic patients exercised to lower work levels than asymptomatic subjects (184 +/- 27 and 307 +/- 32 kg.m/min, respectively, p = 0.02). Ejection fraction failed to increase with exercise in either group. Symptomatic subjects had supranormalization of early diastolic filling with shorter time to the peak filling rate than asymptomatic subjects (137 +/- 16 and 172 +/- 9 ms, respectively, p < 0.05) and a greater first 1/3 filling fraction. The 10 patients who became symptomatic during follow-up had higher first 1/3 filling fractions (53 +/- 7 and 42 +/- 5%, respectively) and mean gradients (41 +/- 4 and 33 +/- 2 mm Hg, respectively) than subjects who remained asymptomatic, p < 0.05. High mean aortic gradients, impaired exercise tolerance and enhanced early diastolic filling distinguish symptomatic from asymptomatic patients.
authors.affiliation: Veterans Administration Medical Center, Minneapolis, Minnesota 55417.
authors.forename: S L
authors.initials: SL
authors.lastname: Archer
authors.forename: D K
authors.initials: DK
authors.lastname: Mike
authors.forename: M B
authors.initials: MB
authors.lastname: Hetland
authors.forename: K L
authors.initials: KL
authors.lastname: Kostamo
authors.forename: R B
authors.initials: RB
authors.lastname: Shafer
authors.forename: E
authors.initials: E
authors.lastname: Chesler
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000503:physiopathology*; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000503:physiopathology*; D003971:Diastole / Q000502:physiology; D004452:Echocardiography; D005080:Exercise Test; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011875:Radionuclide Angiography; D016277:Ventricular Function, Left / Q000502:physiology*