Exercise-induced left ventricular dysfunction in symptomatic and asymptomatic patients with aortic regurgitation: Assessment with radionuclide cineangiography

Borer, Jeffrey S.; Bacharach, Stephen L.; Green, Michael V.; Kent, Kenneth M.; Henry, Walter L.; Rosing, Douglas R.; Seides, Stuart F.; Johnston, Gerald S.; Epstein, Stephen E.

doi:10.1016/0002-9149(78)90927-x

Cited by 240 publications

(32 citation statements)

References 15 publications

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“…-7 The responses of either left ventricular filling pressure and of left ventricular ejection fraction to dynamic exercise as well as exercise capacity have been suggested as three criteria that might be of value in making this determination. [8][9][10] The effects of dynamic exercise in patients with AR are not fully understood, especially regarding the relative effects of changes in heart rate, preload, afterload, and left ventricular contractility. 1 14 Reduction of systemic vascular resistance (SVR) with arteriolar dilators has been shown to favorably affect the redistribution of total left ventricular stroke volume such that forward stroke volume with mild-to-moderate and severe AR, the effects of dynamic exercise on (1) Intracardiac and intravascular pressures and cardiac output, (2) the redistribution of total left ventricular stroke volume into forward stroke volume and RgV and its relationship to changes in the systemic vascular resistance (SVR), and (3) changes in left ventricular ejection fraction.…”

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confidence: 99%

Cardiovascular response to dynamic exercise in patients with chronic symptomatic mild-to-moderate and severe aortic regurgitation.

Kawanishi¹,

McKay²,

Chandraratna³

et al. 1986

Circulation

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Fifteen patients with symptomatic mild-to-moderate and severe chronic aortic regurgitation (AR) performed supine bicycle exercise while measurements of rest (1) in patients with mild-to-moderate AR, the PAWP is generally normal at rest and exercise, (2) in most of those with severe AR, the PAWP is elevated at rest and increases significantly with exercise, which is the likely mechanism for dyspnea on exertion in these patients, (3) the cardiac index in both groups is normal at rest and increases on exercise, (4) the increase in cardiac output results from both an increased heart rate and forward stroke volume, (5) the increase in forward stroke volume results from reductions of RgV and RgF, (6) the RgV and RgF are decreased due to a decreased SVR, and (7) the ejection fraction response to exercise is variable and correlates best with changes in SVR with exercise.

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confidence: 99%

Cardiovascular response to dynamic exercise in patients with chronic symptomatic mild-to-moderate and severe aortic regurgitation.

Kawanishi¹,

McKay²,

Chandraratna³

et al. 1986

Circulation

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“…However, only a few studies with a small number of patients have evaluated AR with quantitative exercise stress imaging. [19][20][21][22][23][24][25] When performed, attention should be focused on LV ejection fraction at exercise. Using radionuclide ventriculography, Borer et al 20 showed abnormal exercise LV ejection fraction to be common in patients with AR and normal LV function at rest.…”

Section: Discussionmentioning

confidence: 99%

“…[19][20][21][22][23][24][25] When performed, attention should be focused on LV ejection fraction at exercise. Using radionuclide ventriculography, Borer et al 20 showed abnormal exercise LV ejection fraction to be common in patients with AR and normal LV function at rest. However, the observed magnitude of change in ejection fraction from rest to exercise seems to be related not only to myocardial contractile function, but also to severity of volume overload and exercise-induced changes in preload and peripheral resistances.…”

Section: Discussionmentioning

confidence: 99%

“…23 However, the subgroup with an abnormal ejection fraction response to exercise was characterized by an increase in peak systolic wall stress. When the changes in LV ejection fraction with exercise were normalized for the changes in end-systolic wall stress, Borer et al 20 showed that this complex parameter independently predicted the outcome. Subsequent studies confirmed that failure to reduce end-systolic volume or increase the ejection fraction at exercise was specific for predicting LV dysfunction at follow-up, with earlier need for surgery 24 and higher event rates.…”

Section: Discussionmentioning

confidence: 99%

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Stress Echocardiography in Regurgitant Valve Disease

Lancellotti

Magné

2013

Circ: Cardiovascular Imaging

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Lancellotti and Magne Stress Echocardiography in Valve Regurgitation 841our echocardiography laboratory for an exercise stress echocardiography. The patient had no reference to comorbidities and medication. Previous echocardiography reported the presence of moderate primary MR without harmful consequences to the LV (ie, no dilation/dysfunction) and no PHT. The resting echocardiogram confirmed these previous findings and noted the presence of a P2 prolapse, an A2 billowing without obvious leaflet tissue redundancy, and calcification of the anterior mitral annulus. The presence of moderate MR was confirmed by the quantitative assessment of MR severity (ie, an average of both proximal isovelocity surface area (PISA) and Doppler volumetric methods; effective regurgitant orifice [ERO], 27 mm 2 ; regurgitant volume, 49 mL; Figure 2). The LV dimension was normal, the LV ejection fraction was 63% using the Simpson method, and the SPAP was 35 mm Hg. The patient reached an exercise load of 125 W (9 metabolic equivalents This case emphasizes the fact that primary MR may be dynamic and significantly worsen during exercise, frequently resulting in the development of exercise PHT. As a result of these exercise findings, it was decided that this patient would be followed up closely every 6 months rather than being monitored every 1 to 2 years as recommended in the guidelines. After 1.5-year follow-up, the patient developed severe MR at rest and overt signs of low-exercise abnormal dyspnea and was then referred for mitral valve repair. Dynamic PHTA 57-year-old inactive woman with moderate obesity (body mass index, 32 kg/m 2 ), diabetes mellitus, systemic hypertension, and a loud systolic murmur was referred to our echocardiographic laboratory in June 2009. The patient reported ambiguous symptoms, such as mild dyspnea when climbing stairs, and had a normal sinus rhythm. At rest, the echocardiogram revealed the presence of a mitral flail leaflet associated with severe MR. The LV ejection fraction was normal (68%), the LV was not dilated (LV end-systolic diameter, 38 mm), and the SPAP was slightly elevated (44 mm Hg). At a low level of exercise (ie, 75 W), the MR degree seemed to be more severe than at rest (quantification inaccurate because of poor quality images). Concomitantly, the patient developed severe dyspnea and stopped the test. In contrast to MR severity quantification, the measurement of SPAP was feasible and showed exercise PHT (SPAP, 87 mm Hg). This case also underlines the fact that exercise can induce an increase in MR severity that can trigger exercise PHT and dyspnea. During follow-up, the patient developed resting dyspnea and fatigue and underwent isolated mitral valve surgery in July 2010. Contractile Functional ReserveA 68-year-old asymptomatic man with moderate-to-severe MR (ERO, 36 mm 2 ; regurgitant volume, 54 mL) caused by Barlow disease was examined in our heart valve clinic 7 in September 2011. The patient had no valvular indication for surgery. During exercise, the patient exhibited a significant incre...

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“…The role of stress protocols for evaluation of LV function in this group is therefore more controversial. Using radionuclide ventriculography, Borer et al showed abnormal exercise ejection fraction to be common in asymptomatic and especially symptomatic patients with aortic regurgitation but normal LV function at rest [39] . However, in 77 minimally symptomatic patients, Bonow et al showed that the ejection fraction response to stress was related to the degree of LV dilation at rest, with reduction of exercise ejection fraction in 90% of patients with an end-systolic dimension >50 mm [40] .…”

Section: Aortic Regurgitationmentioning

confidence: 99%

Application of Stress Echocardiography to the Evaluation of Non-coronary Heart Disease

Marwick

2000

European Journal of Echocardiography

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Exercise-induced left ventricular dysfunction in symptomatic and asymptomatic patients with aortic regurgitation: Assessment with radionuclide cineangiography

Cited by 240 publications

References 15 publications

Cardiovascular response to dynamic exercise in patients with chronic symptomatic mild-to-moderate and severe aortic regurgitation.

Cardiovascular response to dynamic exercise in patients with chronic symptomatic mild-to-moderate and severe aortic regurgitation.

Stress Echocardiography in Regurgitant Valve Disease

Application of Stress Echocardiography to the Evaluation of Non-coronary Heart Disease

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