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Titolo:
Exercise echocardiography predicts development of left ventricular dysfunction in medically and surgically treated patients with asymptomatic severe aortic regurgitation
Autore:
Wahi, S; Haluska, B; Pasquet, A; Case, C; Rimmerman, CM; Marwick, TH;
Indirizzi:
Univ Queensland, Princess Alexandra Hosp, Dept Med, Brisbane, Qld 4102, Australia Univ Queensland Brisbane Qld Australia 4102 Brisbane, Qld 4102, Australia Cleveland Clin Fdn, Cleveland, OH 44195 USA Cleveland Clin Fdn Cleveland OH USA 44195 in Fdn, Cleveland, OH 44195 USA
Titolo Testata:
HEART
fascicolo: 6, volume: 84, anno: 2000,
pagine: 606 - 614
SICI:
1355-6037(200012)84:6<606:EEPDOL>2.0.ZU;2-Z
Fonte:
ISI
Lingua:
ENG
Soggetto:
PRACTICE GUIDELINES COMMITTEE; WAVE DOPPLER ULTRASOUND; ASSOCIATION TASK-FORCE; END-SYSTOLIC DIMENSION; VALVE-REPLACEMENT; SYMPTOMATIC PATIENTS; NATURAL-HISTORY; OPERATIVE INTERVENTION; CONTRACTILE RESERVE; ACC/AHA GUIDELINES;
Keywords:
aortic regurgitation; contractile reserve; exercise testing; ejection fraction;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
35
Recensione:
Indirizzi per estratti:
Indirizzo: Marwick, TH Univ Queensland, Princess Alexandra Hosp, Dept Med, Ipswich Rd, Brisbane, Qld 4102, Australia Univ Queensland Ipswich Rd Brisbane Qld Australia 4102 stralia
Citazione:
S. Wahi et al., "Exercise echocardiography predicts development of left ventricular dysfunction in medically and surgically treated patients with asymptomatic severe aortic regurgitation", HEART, 84(6), 2000, pp. 606-614

Abstract

Objective-To assess resting and exercise echocardiography for prediction of left ventricular dysfunction in patients with significant asymptomatic aortic regurgitation. Design-Cohort study of patients with aortic regurgitation. Setting-Tertiary referral centre specialising in valvar surgery. Patients-61 patients (38 men, 23 women; mean (SD) age 53 (14) years) with asymptomatic or minimally symptomatic aortic regurgitation and no known coronary artery disease; 35 were treated medically and 26 had aortic valve replacement. Interventions-Exercise echocardiography was used to evaluate ejection fraction, which was measured on the resting and post-stress images using the modified Simpson method. Patients with an increment of ejection fraction after exercise were denoted as having contractile reserve (CR+); those without an increment were labelled CR-. Main outcome measures-Standard univariate and multivariate methods and receiver operating characteristic analyses were used to assess the ability of contractile reserve to predict follow up ejection fraction. Results-In the 35 medically treated patients, 13 of 21 (62%) with CR+ (mean (SD) ejection fraction increment 7 (3)%) had preserved ejection fraction on follow up. Inre 14 patients with CR(ejection fraction decrement 8 (4)%), 13 (93%) had adecrement of ejection fraction on follow up from 60 (5)% at baseline to 54(3)% on follow up (p = 0.005). Age, resting left ventricular dimensions, medical treatment, aortic regurgitation severity exercise capacity, and rate-pressure product were similar in both CR+ and CR- groups. Among the 26 surgical patients, 13 showed CR+ (ejection fraction increase 9 (5)%), all of whom had an increase in ejection fraction on follow up (from 49% to 59%). Of13 surgical patients with CR- (ejection fraction decrease 7 (5)%), 10 (77%) showed the same or worse ejection fraction on postoperative follow up. Conclusions-Contractile reserve on exercise echocardiography is a better predictor of left ventricular decompensation than resting indices in asymptomatic patients with aortic regurgitation. In patients undergoing aortic valve replacement, contractile reserve had a better correlation with resting ejection fraction on postoperative follow up. Measurement of contractile reserve may be useful to monitor the early development of myocardial dysfunction in asymptomatic patients with aortic regurgitation, and may help to optimise the timing of surgery.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 30/05/20 alle ore 14:59:33