Decreases in left atrial compliance during early-stage exercise are related to exercise intolerance in asymptomatic significant mitral stenosis

被引:8
作者
Jung, Mi-Hyang [1 ]
Jung, Hae Ok [1 ]
Lee, Jung-Won [1 ]
Youn, Ho-Joong [1 ]
机构
[1] Catholic Univ Korea, Seoul St Marys Hosp, Coll Med, Div Cardiol,Dept Internal Med, Seoul, South Korea
来源
ECHOCARDIOGRAPHY-A JOURNAL OF CARDIOVASCULAR ULTRASOUND AND ALLIED TECHNIQUES | 2017年 / 34卷 / 11期
关键词
exercise echocardiography; exercise tolerance; left atrium; mitral stenosis; pulmonary hypertension; NET ATRIOVENTRICULAR COMPLIANCE; PULMONARY-ARTERY PRESSURE; VALVE AREA; STRESS ECHOCARDIOGRAPHY; IMPACT; HYPERTENSION; CAPACITY;
D O I
10.1111/echo.13666
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
BackgroundDoppler-driven net atrioventricular compliance (C-n), which represents left atrial (LA) compliance, is an important determinant of pulmonary hypertension in mitral stenosis (MS). HypothesisWe hypothesized that decreases in C-n during early-stage exercise underlie exercise intolerance in patients with MS. MethodsThirty-three asymptomatic patients with significant MS (valve area 1.240.16cm(2)) underwent resting and bicycle exercise echocardiography. LA compliance and conventional parameters were assessed at each workload. The patients were classified into two groups based on whether they developed dyspnea during exercise: an exercise-intolerance group (n=22) and an exercise-tolerance group (n=11). Moreover, 50W was defined as an early exercise stage. ResultsAlthough the groups had similar resting characteristics, there were striking differences in their echocardiographic parameters from the early stages of exercise. The relative C-n decrease at 50W (expressed as a percentage of the resting C-n) was significantly greater in the exercise-intolerance group (70.3 +/- 15.4% vs 49.7 +/- 9.7%, P<.001). The overall decrease in relative C-n was significantly greater in the exercise-intolerance group (P=.0005). Furthermore, differences in the trends in this parameter were observed between the two groups (P<.0001 for interaction). Multivariate analysis revealed that the relative C-n decrease at 50W was an independent predictor of exercise intolerance (adjusted OR 1.105, 95% CI 1.030-1.184) after adjustment for other conventional parameters. ConclusionsDecreases in C-n during early-stage exercise are an important mechanism underlying exercise intolerance in MS.
引用
收藏
页码:1633 / 1639
页数:7
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