Heart Centre, Umeå University, Umeå, Sweden.
Eur Heart J Cardiovasc Imaging. 2012 Apr;13(4):353-60. doi: 10.1093/ejechocard/jer246. Epub 2011 Nov 18.
Despite recovery of left ventricular (LV) function and morphology after aortic valve replacement (AVR) for aortic stenosis (AS), its relationship with exercise capacity remains unknown. Twenty-one AVR patients (age 61 ± 12 years, 14 male) with normal ejection fraction (EF, 64 ± 7%) and 21 age- and sex-matched controls (57 ± 9 years, 10 male, EF 68 ± 8%) were studied.
All subjects performed semi-supine bicycle exercise and speckle tracking echocardiography (STE) study. Peak oxygen consumption (pVO(2)) was collected during semi-supine bicycle exercise. Systolic (GLSRs) and early diastolic (GLSRe) longitudinal strain rate using STE and Doppler echocardiographic parameters were measured at rest, submaximal, peak exercise, and 4 min after exercise. The two groups had comparable resting echocardiographic measurements. At peak exercise, pVO(2) was lower in patients than controls (18.5 ± 4.5 vs. 22.1 ± 4.3 L/min/kg, P < 0.05). GLSRs (0.98 ± 0.28 vs. 1.55 ± 0.30 1/s, P < 0.001), septal Sm (7.9 ± 1.4 vs. 11.1 ± 2.3 cm/s, P < 0.001) and their changes between rest and peak exercise (ΔGLSRs: 0.16 ± 0.33 vs. 0.68 ± 0.27 1/s, P < 0.001; ΔSm 2.29 ± 2.23 vs. 4.63 ± 2.29 cm/s, P < 0.01) were significantly lower in patients than controls. There was no correlation between pVO(2) and any echocardiographic measurements in controls. In patients, pVO(2) correlated with peak exercise GLSRs (r = 0.60, P = 0.0007), septal Sm (r = 0.65, P = 0.002), and Em (r = 0.57, P = 0.009). In a multivariate model, peak exercise GLSRs (β = 7.18, P = 0.03) was the only independent predictor of pVO(2) in the patients group.
Exercise capacity is subnormal after AVR for AS, irrespective of normal LVEF suggesting residual compromised myocardial functional reserve.
尽管主动脉瓣置换术（AVR）可恢复主动脉瓣狭窄（AS）患者的左心室（LV）功能和形态，但它与运动能力的关系仍不清楚。本研究纳入了 21 例接受 AVR 的 AS 患者（年龄 61 ± 12 岁，14 名男性）和 21 名年龄和性别匹配的对照组（57 ± 9 岁，10 名男性，EF 68 ± 8%）。
所有患者均接受半卧位踏车运动和斑点追踪超声心动图（STE）检查。在半卧位踏车运动期间采集峰值摄氧量（pVO2）。在休息、亚最大、峰值运动和运动后 4 分钟时使用 STE 和多普勒超声心动图参数测量收缩期（GLSRs）和早期舒张期（GLSRe）纵向应变率。两组的静息超声心动图测量值无差异。在峰值运动时，患者的 pVO2 低于对照组（18.5 ± 4.5 比 22.1 ± 4.3 L/min/kg，P < 0.05）。GLSRs（0.98 ± 0.28 比 1.55 ± 0.30 1/s，P < 0.001）、室间隔 Sm（7.9 ± 1.4 比 11.1 ± 2.3 cm/s，P < 0.001）及其在休息与峰值运动之间的变化（ΔGLSRs：0.16 ± 0.33 比 0.68 ± 0.27 1/s，P < 0.001；ΔSm：2.29 ± 2.23 比 4.63 ± 2.29 cm/s，P < 0.01）在患者中均明显低于对照组。在对照组中，pVO2 与任何超声心动图测量值均无相关性。在患者中，pVO2 与峰值运动 GLSRs（r = 0.60，P = 0.0007）、室间隔 Sm（r = 0.65，P = 0.002）和 Em（r = 0.57，P = 0.009）相关。在多变量模型中，峰值运动 GLSRs（β = 7.18，P = 0.03）是患者组中 pVO2 的唯一独立预测因子。
AS 患者接受 AVR 后运动能力降低，尽管左心室射血分数正常，但提示心肌功能储备仍然受损。
