Effects of aortic valve replacement on exercise duration and functional status in adults with valvular aortic stenosis.
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.


METHODS
Prospective study of initially asymptomatic patients with pre- and postvalve replacement echocardiography, functional status score and exercise data.


METHODS
University-affiliated, tertiary care teaching hospital.


METHODS
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).


METHODS
Annual Doppler echocardiography, functional status questionnaires and, if possible, Bruce protocol maximal exercise tolerance tests.


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.
Munt
B I
BI
Department of Medicine, University of Washington, Seattle 98195, USA.
Legget
M E
ME
Healy
N L
NL
Fujioka
M
M
Schwaegler
R
R
Otto
C M
CM
D000368:Aged; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology* / Q000601:surgery*; D015150:Echocardiography, Doppler; D005080:Exercise Test; D005260:Female; D006350:Heart Valve Prosthesis; D006352:Heart Ventricles / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left