Effect of exercise on indices of valvular aortic stenosis

Abstract

Changes in the physiologic state of the patient may affect indices of valvular aortic stenosis. We determined the effects of supine exercise on the Gorlin valve area, Cannon valve area, aortic valve resistance, and a modified stroke work loss index in 80 patients with aortic stenosis. Exercise caused a significant increase in the Gorlin and Cannon valve area, while work loss and valve resistance decreased significantly. The average percent change in work loss, 12.2%, was lower than the other indices (P less than 0.02), i.e., 15.3% for valve resistance, 18.6% for the Gorlin area, and 19.3% for the Cannon area. The correlation between the rest and exercise measurements was highest for work loss (r = 0.94), compared to 0.93, 0.88, and 0.89 for the other 3 indices, respectively. In patients with a Gorlin area below 1 cm2, exercise caused a significant decrease in work loss, but not Cannon area or valve resistance. However, the percent change was significantly lower and the correlation was better with the work loss index. We conclude that the work loss index is less affected by supine exercise than other indices of aortic stenosis.

Determinants of an abnormal response to exercise in patients with asymptomatic valvular aortic stenosis

“…11 Haemodynamic effects of exercise in valvular AS have been studied during catheterization 18,19 ; Doppler recordings have been obtained immediately after exercise. 2,[20][21][22] The present study is one of the first that aimed to obtain Doppler haemodynamics during exercise in patients with asymptomatic AS. We used a dedicated table with the patient lying in a comfortable position that permitted adequate recording of Doppler velocities: this is technically less demanding than recording these data quickly and accurately immediately after exercise.…”

Abnormal ventricular repolarization in long QT syndrome carriers is related to short left ventricular filling time and attenuated stroke volume response during exercise

“…Our results also did not show any compensatory increase in transmitral flow velocities during exercise . The end product of those disturbances and of the lack of potential compensation for the restricted LV filling time is the reduced stroke volume …”

Is aortic valve resistance more clinically meaningful than valve area in aortic stenosis?

“…Martin et al observed that aortic valve resistance was less influenced by exercise induced increase in cardiac output than Gorlin valve area as measured by cardiac catheterisation 5. Burwash et al found a similar flow dependence for aortic valve area and resistance evaluated by Doppler echocardiography during exercise 6.…”