Maréchaux Sylvestre, Ennezat Pierre-Vladimir, LeJemtel Thierry H, Polge Anne-Sophie, de Groote Pascal, Asseman Philippe, Nevière Rémi, Le Tourneau Thierry, Deklunder Ghislaine
Cardiology Hospital, Lille University Medical Center, CRHU Lille, Boulevard Pr J Leclerc, Lille, France.
Echocardiography. 2007 Oct;24(9):955-9. doi: 10.1111/j.1540-8175.2007.00501.x.
While normal at rest, left ventricular (LV) systolic function may become abnormal during exercise in patients with aortic stenosis. Once contraindicated in patients with aortic stenosis, exercise testing is now recommended in asymptomatic patients with aortic stenosis to elicit symptoms and thereby ascertain the need for aortic valve replacement. However, the clinical significance of an abnormal LV response to exercise in asymptomatic patients with aortic stenosis remains unknown.
The aim of this study was to evaluate the clinical implications of an abnormal LV response during exercise in the setting of aortic stenosis.
We monitored the LV response to exercise by 2D-Doppler echocardiography during a symptom limited semirecumbent bicycle exercise in 50 patients with tight aortic stenosis (aortic valve area < or = 1.0 cm(2)) and a normal LV systolic function (LV ejection fraction, EF > or = 50%) and followed them for an average of 11 months.
Twenty patients had an abnormal LV response to exercise with a mean decrease in LV EF from 64 +/- 10 to 53 +/- 12% while 30 patients had a normal LV response to exercise with a mean increase in LV EF from 62 +/- 7 to 70 +/- 8%. Patients with an abnormal LV response during exercise were more likely to develop symptoms during exercise than patients with a normal LV response: 80% versus 27% (P< 0.0001). The survival free of cardiac events was significantly lower in patients with abnormal LV response to exercise than in patients with a normal response (P = 0.03).
Exercise echocardiography provides objective data that facilitate interpretation of exercise elicited symptoms in asymptomatic patients with severe aortic stenosis. In addition, an abnormal LV response to exercise may predict a poor outcome.
主动脉瓣狭窄患者在静息时左心室（LV）收缩功能正常，但运动时可能会出现异常。运动试验曾被视为主动脉瓣狭窄患者的禁忌，而现在对于无症状的主动脉瓣狭窄患者，推荐进行运动试验以诱发症状，从而确定是否需要进行主动脉瓣置换。然而，无症状主动脉瓣狭窄患者运动时左心室异常反应的临床意义仍不明确。
本研究旨在评估主动脉瓣狭窄情况下运动时左心室异常反应的临床意义。
我们通过二维多普勒超声心动图监测了50例重度主动脉瓣狭窄（主动脉瓣面积≤1.0 cm²）且左心室收缩功能正常（左心室射血分数，EF≥50%）的患者在症状限制的半卧位自行车运动过程中左心室对运动的反应，并对他们进行了平均11个月的随访。
20例患者运动时左心室反应异常，左心室EF平均从64±10%降至53±12%，而30例患者运动时左心室反应正常，左心室EF平均从62±7%增至70±8%。运动时左心室反应异常的患者比反应正常的患者在运动时更易出现症状：分别为80%和27%（P<0.0001）。运动时左心室反应异常的患者无心脏事件生存明显低于反应正常的患者（P = 0.03）。
运动超声心动图提供了客观数据，有助于解读无症状重度主动脉瓣狭窄患者运动诱发的症状。此外，运动时左心室异常反应可能预示不良预后。
