Abstract:
PURPOSE:Severe valve lesions require corrective interventions to avoid progression to heart failure (HF) and premature demise. We tested the hypothesis that despite operative risks, corrective valvular interventions will lead to significant improvements in overall cardiac pump function, especially before the onset of cardiac decompensation. METHODS:We compared the cardiopulmonary exercise performance and non-invasive haemodynamics of 46 consecutive patients with severe valvular disease before and after valvular intervention with reference to 101 healthy male and 139 female controls without cardiovascular disease. Cardiac and physical functional reserves were measured with standard respiratory gas analyses and CO2 rebreathing to measure cardiac output non-invasively during peak treadmill exercise. Data are given as mean ± SD and statistical significance accepted at P<0.05. RESULTS:The entire patient cohort showed no significant improvement in peak O2 consumption (V˙O2max, P=0.74) or in peak cardiac power (CPOmax, P=0.34) after valvular intervention, but we found instead a dichotomous outcome depending on preoperative cardiac function: (i) the pre-operative cardiac decompensatory subgroup (LoW, n=26) showed increased CPOmax (2.63 ± 0.67 to 3.42 ± 0.98 W, P<0.0001) and V˙O2max (1.38 ± 0.55 to 1.56 ± 0.59 L·min(-1), P<0.01); and (ii) the pre-operative non-decompensatory subgroup (HiW) showed reduced CPOmax (4.58 ± 0.96 to 3.84 ± 0.92 W, P<0.001) and V˙O2max (2.29 ± 0.72 to 1.97 ± 0.75 L·min(-1), P<0.01). Changes in NYHA class were found to be discrepant with these objective measurements. CONCLUSION:This investigation found an unexpected finding that valvular interventions performed in routine clinical practice do not consistently improve cardiac function, especially in those without pre-operative cardiac decompensation. Assessing cardiac functional gains would open up new avenues for future trials of valvular interventions.
journal_name
Int J Cardioljournal_title
International journal of cardiologyauthors
Tan DK,Hothi SS,Macdonald W,Schlosshan D,Tan LBdoi
10.1016/j.ijcard.2015.03.177subject
Has Abstractpub_date
2015-01-01 00:00:00pages
491-501eissn
0167-5273issn
1874-1754pii
S0167-5273(15)00416-7journal_volume
187pub_type
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journal_title:International journal of cardiology
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journal_title:International journal of cardiology
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journal_title:International journal of cardiology
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journal_title:International journal of cardiology
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pub_type: 杂志文章,多中心研究
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journal_title:International journal of cardiology
pub_type: 杂志文章
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journal_title:International journal of cardiology
pub_type: 临床试验,杂志文章,随机对照试验
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journal_title:International journal of cardiology
pub_type: 杂志文章,评审
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journal_title:International journal of cardiology
pub_type: 杂志文章
doi:10.1016/0167-5273(87)90274-9
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journal_title:International journal of cardiology
pub_type: 杂志文章
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journal_title:International journal of cardiology
pub_type: 杂志文章
doi:10.1016/j.ijcard.2007.07.003
更新日期:2008-07-04 00:00:00
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pub_type: 杂志文章,评审
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