Afoke Jonathan, Mohal Jagdeep, Kanaganayagam Gajen Sunthar, Casula Roberto, Bruno Vito, Howard Luke, Gibbs Simon, Punjabi Prakash
Department of Cardiothoracic Surgery, Imperial College Healthcare NHS Trust, London, UK.
National Heart and Lung Institute, Imperial College, London, UK.
Perfusion. 2023 Oct 18:2676591231207735. doi: 10.1177/02676591231207735.
Our aim is to describe the use of cardiopulmonary exercise testing in watchful waiting for asymptomatic severe primary mitral regurgitation.
Between October 2016 and October 2017, ten patients with asymptomatic severe primary mitral regurgitation underwent watchful waiting in a single centre. Baseline assessment included history, physical examination, transthoracic echocardiogram and cardiopulmonary exercise testing. Patients were re-evaluated every 6 months with history, physical examination and transthoracic echocardiogram; and at 12 months with cardiopulmonary exercise testing.
At 1 year follow up, five patients remained asymptomatic with no significant change in left ventricular ejection fraction ( = 0.18). This was associated with no significant change in cardiopulmonary exercise testing parameters. However, five patients developed early new symptoms or changes in echocardiographic parameters with a significant fall in left ventricular ejection fraction ( < 0.01). This was associated with a significant fall in anaerobic threshold ( = 0.04) and four of the five patients having an abnormal percentage predicted peak VO2 at 1 year follow up.
Changes in symptomatic status or echocardiographic parameters during a watchful waiting approach for asymptomatic severe primary mitral regurgitation is associated with a significant reduction in cardiopulmonary exercise testing parameters.
我们的目的是描述心肺运动试验在无症状严重原发性二尖瓣反流观察等待中的应用。
2016年10月至2017年10月，10例无症状严重原发性二尖瓣反流患者在单一中心接受观察等待。基线评估包括病史、体格检查、经胸超声心动图和心肺运动试验。每6个月对患者进行病史、体格检查和经胸超声心动图重新评估；12个月时进行心肺运动试验。
在1年随访时，5例患者仍无症状，左心室射血分数无显著变化（ = 0.18）。这与心肺运动试验参数无显著变化相关。然而，5例患者出现早期新症状或超声心动图参数改变，左心室射血分数显著下降（ < 0.01）。这与无氧阈值显著下降（ = 0.04）相关，5例患者中有4例在1年随访时预测的峰值VO2百分比异常。
无症状严重原发性二尖瓣反流观察等待期间症状状态或超声心动图参数的变化与心肺运动试验参数的显著降低相关。
