Abstract 9919: Incremental Values of Resting and Exercise Cardiac Dysfunction for Prediction of Outcome in Asymptomatic Aortic Regurgitation
Background: The role of exercise echocardiography in decision-making regarding surgical timing for aortic regurgitation (AR) remains a matter of debate, because there are limited data on its link with outcome. The aim of this study was to assess the role of echocardiographic measurements at rest and during exercise as predictors of prognosis in asymptomatic aortic regurgitation.
Methods and Results: Comprehensive resting and exercise echocardiography was performed in 164 consecutive patients (50±15y; 78% male) with isolated moderate to severe AR and preserved left ventricular (LV) function (LV ejection fraction >50%, LV end-diastolic dimension ≤70mm, LV end-systolic dimension ≤50mm or ≤25mm/m2) in whom initial management was expectant. Echocardiographic measurements were performed at rest and during exercise. LV and right ventricular (RV) longitudinal strain was analyzed at rest using velocity vector imaging. Valve surgery was performed in 38 patients (23%) over 33±12 months. After adjustment for age and gender in a multivariable Cox proportional hazards model, exercise tricuspid annular plane systolic excursion (TAPSE) (HR=0.81, p=0.002) was associated with valve surgery-free survival, independent of resting LV strain (HR=1.16, p=0.043), exercise LV end-diastolic volume (HR=1.01, p=0.134) and resting RV strain (HR=1.17, p=0.009). In sequential Cox models, a model based on clinical data (chi-square, 25.6) was improved by resting LV strain (chi-square, 30.1, p=0.010), resting RV strain (chi-square, 46.0, p=0.001) and further increased by exercise TAPSE (chi-square, 56.7, p=0.001)(Figure).
Conclusions: In asymptomatic AR, resting LV strain, resting RV strain and exercise TAPSE were independently associated with the need for earlier aortic surgery.
- © 2013 by American Heart Association, Inc.