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Prognostic value of exercise left ventricular end-systolic volume index in patients with asymptomatic aortic regurgitation: an exercise echocardiography study

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Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

Exercise LVESVi might be an independent predictor of prognosis in patients with asymptomatic moderate or severe AR.

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Authors and Affiliations

  1. Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan

    Yukio Sato, Masaki Izumo, Kengo Suzuki, Seisyou Kou, Kihei Yoneyama, Maya Tsukahara, Kanako Teramoto, Keisuke Minami, Shingo Kuwata, Ryo Kamijima, Kei Mizukoshi, Akio Hayashi, Eiji Ohtaki, Tomoo Harada & Yoshihiro J. Akashi

  2. Department of Laboratory Medicine, St. Marianna University School of Medicine, Kawasaki, Japan

    Sachihiko Nobuoka

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  1. Yukio Sato
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  2. Masaki Izumo
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  3. Kengo Suzuki
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  16. Yoshihiro J. Akashi
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Corresponding author

Correspondence to Yoshihiro J. Akashi.

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Conflict of interest

Yukio Sato, Masaki Izumo, Kengo Suzuki, Seisyou Kou, Kihei Yoneyama, Maya Tsukahara, Kanako Teramoto, Keisuke Minami, Shingo Kuwata, Ryo Kamijima, Kei Mizukoshi, Akio Hayashi, Sachihiko Nobuoka, Eiji Ohtaki, Tomoo Harada, and Yoshihiro J. Akashi declare that they have no conflicts of interest.

Human rights statements and informed consent

The present study was performed in accordance with the ethical principles set forth in the Declaration of Helsinki. The study protocol was approved by the St. Marianna University School of Medicine Institutional Committee on Human Resource, Kawasaki, Japan (No. 1288). The participants were well informed prior to the test; written informed consent was obtained before enrollment.

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Sato, Y., Izumo, M., Suzuki, K. et al. Prognostic value of exercise left ventricular end-systolic volume index in patients with asymptomatic aortic regurgitation: an exercise echocardiography study. J Echocardiogr 15, 70–78 (2017). https://doi.org/10.1007/s12574-016-0323-3

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  • DOI: https://doi.org/10.1007/s12574-016-0323-3

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