title: Prognostic value of exercise left ventricular end-systolic volume index in patients with asymptomatic aortic regurgitation: an exercise echocardiography study.
abstract: Surgical timing of chronic aortic regurgitation (AR) remains a matter of debate because of limited data. This study assessed the prognostic value of exercise echocardiography in asymptomatic AR.
  
  
  
  This prospective study included 60 consecutive asymptomatic patients with isolated moderate or severe AR (mean regurgitant volume 56.7 ± 11.8 ml) and preserved ejection fraction who underwent exercise echocardiography. The clinical outcomes were defined by the presence of major adverse cardiovascular events (MACE) and the indication for aortic valve replacement (AVR) with class I or IIa classification in the current guidelines.
  
  
  
  During the average follow-up of 731 days, 12 patients suffered from the clinical events, including two patients developing MACE (3%) and ten patients indicating for AVR (17%). No difference in left ventricular (LV) ejection fraction at rest was found between the patients with and without the clinical events. The indexed LV diameters and LV volumes were significantly dilated in the patients with the clinical events. The Cox proportional hazards regression analysis resulted that the exercise LV end-systolic volume index (LVESVi) was significantly associated with the clinical outcomes [hazard ratio, 1.116; 95% CI (1.032-1.205); p = 0.006]. The Kaplan-Meier analysis showed that exercise LVESVi was clearly stratified the event-free survival.
  
  
  
  Exercise LVESVi might be an independent predictor of prognosis in patients with asymptomatic moderate or severe AR.
authors.affiliation: Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan.
authors.forename: Yukio
authors.initials: Y
authors.lastname: Sato
authors.affiliation: Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan.
authors.forename: Masaki
authors.initials: M
authors.lastname: Izumo
authors.affiliation: Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan.
authors.forename: Kengo
authors.initials: K
authors.lastname: Suzuki
authors.affiliation: Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan.
authors.forename: Seisyou
authors.initials: S
authors.lastname: Kou
authors.affiliation: Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan.
authors.forename: Kihei
authors.initials: K
authors.lastname: Yoneyama
authors.affiliation: Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan.
authors.forename: Maya
authors.initials: M
authors.lastname: Tsukahara
authors.affiliation: Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan.
authors.forename: Kanako
authors.initials: K
authors.lastname: Teramoto
authors.affiliation: Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan.
authors.forename: Keisuke
authors.initials: K
authors.lastname: Minami
authors.affiliation: Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan.
authors.forename: Shingo
authors.initials: S
authors.lastname: Kuwata
authors.affiliation: Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan.
authors.forename: Ryo
authors.initials: R
authors.lastname: Kamijima
authors.affiliation: Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan.
authors.forename: Kei
authors.initials: K
authors.lastname: Mizukoshi
authors.affiliation: Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan.
authors.forename: Akio
authors.initials: A
authors.lastname: Hayashi
authors.affiliation: Department of Laboratory Medicine, St. Marianna University School of Medicine, Kawasaki, Japan.
authors.forename: Sachihiko
authors.initials: S
authors.lastname: Nobuoka
authors.affiliation: Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan.
authors.forename: Eiji
authors.initials: E
authors.lastname: Ohtaki
authors.affiliation: Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan.
authors.forename: Tomoo
authors.initials: T
authors.lastname: Harada
authors.affiliation: Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan. yoakashi-circ@umin.ac.jp.
authors.forename: Yoshihiro J
authors.initials: YJ
authors.lastname: Akashi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001022:Aortic Valve Insufficiency / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery*; D004452:Echocardiography / Q000379:methods; D015444:Exercise; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000379:methods; D006352:Heart Ventricles / Q000000981:diagnostic imaging*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012680:Sensitivity and Specificity
keywords: Aortic regurgitation; Exercise echocardiography