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LEFT ATRIAL RESERVOIR FUNCTION IS IMPAIRED IN REDUCED EXERCISE CAPACITY IN PATIENTS WITH MITRAL STENOSIS
E1411 JACC April 5, 2011 Volume 57, Issue 14
VALVULAR HEART DISEASE LEFT ATRIAL RESERVOIR FUNCTION IS IMPAIRED IN REDUCED EXERCISE CAPACITY IN PATIENTS WITH MITRAL STENOSIS ACC Poster Contributions Ernest N. Morial Convention Center, Hall F Tuesday, April 05, 2011, 9:30 a.m.-10:45 a.m.
Session Title: Valvular Disease- Valvular Heart Disease- Rare and Novel Discoveries Abstract Category: 19. Valvular Disease Session-Poster Board Number: 1154-75 Authors: Makoto Amaki, Hideaki Kanzaki, Yoshiyuki Sumita, Rika Mizuta, Akira Funada, Hiroyuki Takahama, Takuya Hasegawa, Masafumi Kitakaze, National Cerebral and Cardiovascular Center, Suita, Japan Background: In mitral stenosis (MS), developing pulmonary hypertension, which is thought to be determinant of dyspnea, can vary due to the difference of left atrial (LA) compliance despite similar mitral valve area (MVA). We hypothesized that exercise capacity may be associated with LA reservoir function rather than tricuspid regurgitant pressure gradient (TRPG). Methods: Thirty-two patients with MS (age 65±9 years, MVA 1.1±0.4cm2, EF57±5%) underwent exercise echocardiography using bicycle ergometer. MVA was determined by continuous equation. Maximum (LAVmax) and minimum LA volumes (LAVmin) were measured by using biplane area-length method. Atrial reservoir volume (ARV) means the difference between LAVmax and LAVmin. LA reservoir function was estimated as ARV/LAVmax, the percent decrease of LA volume from LAVmax to LAVmin. Results: By exercise, mean transmitral gradient and TRPG increased from 7±3 to 22±8 mmHg (P<0.001) and from 26±9 to 59±12 mmHg (P<0.001), respectively. Maximal exercise load correlated with age (r=-0.53, p<0.01), resting TRPG (r=-0.46, p<0.01) and ARV/LAVmax (r=0.40, p=0.02) but not with MVA and peak exercise TRPG. In multivariate analysis, age, male and ARV/LAVmax remained as the determinant of maximal exercise load. Conclusions: Exercise tolerance was associated with LA reservoir function, rather than pulmonary hypertension during exercise. These findings may support LA compliance limits exercise capacity in MS.
VALVULAR HEART DISEASE LEFT ATRIAL RESERVOIR FUNCTION IS IMPAIRED IN REDUCED EXERCISE CAPACITY IN PATIENTS WITH MITRAL STENOSIS ACC Poster Contributions Ernest N. Morial Convention Center, Hall F Tuesday, April 05, 2011, 9:30 a.m.-10:45 a.m.
Session Title: Valvular Disease- Valvular Heart Disease- Rare and Novel Discoveries Abstract Category: 19. Valvular Disease Session-Poster Board Number: 1154-75 Authors: Makoto Amaki, Hideaki Kanzaki, Yoshiyuki Sumita, Rika Mizuta, Akira Funada, Hiroyuki Takahama, Takuya Hasegawa, Masafumi Kitakaze, National Cerebral and Cardiovascular Center, Suita, Japan Background: In mitral stenosis (MS), developing pulmonary hypertension, which is thought to be determinant of dyspnea, can vary due to the difference of left atrial (LA) compliance despite similar mitral valve area (MVA). We hypothesized that exercise capacity may be associated with LA reservoir function rather than tricuspid regurgitant pressure gradient (TRPG). Methods: Thirty-two patients with MS (age 65±9 years, MVA 1.1±0.4cm2, EF57±5%) underwent exercise echocardiography using bicycle ergometer. MVA was determined by continuous equation. Maximum (LAVmax) and minimum LA volumes (LAVmin) were measured by using biplane area-length method. Atrial reservoir volume (ARV) means the difference between LAVmax and LAVmin. LA reservoir function was estimated as ARV/LAVmax, the percent decrease of LA volume from LAVmax to LAVmin. Results: By exercise, mean transmitral gradient and TRPG increased from 7±3 to 22±8 mmHg (P<0.001) and from 26±9 to 59±12 mmHg (P<0.001), respectively. Maximal exercise load correlated with age (r=-0.53, p<0.01), resting TRPG (r=-0.46, p<0.01) and ARV/LAVmax (r=0.40, p=0.02) but not with MVA and peak exercise TRPG. In multivariate analysis, age, male and ARV/LAVmax remained as the determinant of maximal exercise load. Conclusions: Exercise tolerance was associated with LA reservoir function, rather than pulmonary hypertension during exercise. These findings may support LA compliance limits exercise capacity in MS.