title: Changes in the severity of aortic regurgitation at peak effort during exercise.
abstract: BACKGROUND
  Chronic aortic regurgitation can be well tolerated for a long time. Some patients with normal ventricular function can even reach high levels of sporting performance. How the severity of regurgitation may change during exercise, however, is little known, although some studies suggest it diminishes. The present work examines, during exercise, the functional capacity, ventricular function, and regurgitation fraction (RF) in asymptomatic subjects with moderate or severe aortic regurgitation with preserved ejection fraction.
  
  
  METHODS
  The study subjects (n=32; 23 men, 9 women) were patients referred to our echocardiography laboratory with moderate or severe aortic regurgitation, preserved left ventricular systolic function, and sinus rhythm into NYHA functional class I. All underwent transthoracic echocardiography at rest and at peak effort during an exercise protocol involving an inclined cycloergometer. Left atrial and ventricular volume indices were recorded, along with diastolic and systolic function, cardiac index, peripheral resistance, and RF.
  
  
  RESULTS
  The mean age of the subjects was 43.8±18.2years; 59% suffered moderate regurgitation, 41% severe aortic regurgitation, and 84% had a dilated left ventricle. All subjects managed exercise loads adequate for their age. Peak effort was associated with a significant reduction (mean 44.5% [range 10-95%]) in the RF (21.8±13.2 vs. 39.3%±14.7% at rest; p=0.0001). The absolute reduction in the RF at peak effort was greater among the subjects with severe aortic regurgitation (21.2% vs. 13.3% in those with moderate regurgitation; p=0.018).
  
  
  CONCLUSIONS
  The RF becomes smaller during exercise in asymptomatic subjects with moderate or severe aortic regurgitation and preserved ventricular function.
authors.affiliation: Department of Cardiology, Hospital Universitari Son Espases, Palma de Mallorca, Spain.
authors.forename: José Francisco
authors.initials: JF
authors.lastname: Forteza Albertí
authors.affiliation: Department of Cardiology, Hospital Universitari Son Espases, Palma de Mallorca, Spain.
authors.forename: Marta
authors.initials: M
authors.lastname: Noris Mora
authors.affiliation: Intensive Unit Care, Hospital Universitari Son Espases, Palma de Mallorca, Spain.
authors.forename: Andrés
authors.initials: A
authors.lastname: Carrillo López
authors.affiliation: Department of Cardiology, Hospital Universitari Son Espases, Palma de Mallorca, Spain. Electronic address: papericas@hotmail.com.
authors.forename: Pere
authors.initials: P
authors.lastname: Pericàs
authors.affiliation: Department of Cardiology, Hospital Universitari Son Espases, Palma de Mallorca, Spain.
authors.forename: Lucía
authors.initials: L
authors.lastname: Pasamar Márquez
authors.affiliation: Facultad de Ciencias de la Actividad Física y del Deporte, Universidad Politécnica de Madrid, Madrid, Spain.
authors.forename: Francisco Javier
authors.initials: FJ
authors.lastname: Calderón Montero
authors.affiliation: Department of Cardiology, Hospital Universitari Son Espases, Palma de Mallorca, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Rodríguez Fernández
mesh_terms: D000328:Adult; D001022:Aortic Valve Insufficiency / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology*; D004452:Echocardiography; D015444:Exercise / Q000502:physiology*; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012146:Rest / Q000502:physiology; D012720:Severity of Illness Index; D013318:Stroke Volume / Q000502:physiology; D016277:Ventricular Function, Left / Q000502:physiology*
keywords: Aortic regurgitation; Exercise echocardiography