Key result
Patients with St. Jude mitral valves implanted >5 years ago had a significantly higher percent increase in peak pressure gradient with exercise (>100%) than those <5 years ago (<80%) (p<0.01).
Why the study?
Does exercise Doppler echocardiography detect borderline mitral valve dysfunction in asymptomatic patients with a St. Jude Medical mitral valve?
Observational (n=100)
Does exercise Doppler echocardiography detect borderline mitral valve dysfunction in asymptomatic patients with a St. Jude Medical mitral valve?
Exercise Doppler echocardiography can detect borderline mitral valve dysfunction, characterized by significant gradient increases, in asymptomatic patients more than 5 years after St. Jude Medical valve implantation.
May aid detection of late subclinical dysfunction in asymptomatic St. Jude mitral valves; hypothesis-generating pending prospective validation.
The aim of this study was to detect borderline mitral valve dysfunction in 100 asymptomatic patients with a St. Jude Medical valve. We studied rest and exercise hemodynamics by Doppler echocardiography. Study patients were divided into two groups according to the time since surgery: group A had valves implanted less than 5 years ago (44 patients), group B had valves implanted more than 5 years ago (56 patients). Although patients had no clinical signs of valve dysfunction, group B was found to have significant reduction of mitral valve area (p < 0.05). In the group A patients, mean gradients at rest increased from 4 +/- 2, 4 +/- 2, and 3 +/- 1 mmHg in valve sizes of 25, 27, and 29 mm, respectively, to 7 +/- 2, 7 +/- 3, and 5 +/- 2 mmHg with exercise. In the group B patients, mean gradients at rest increased from 7 +/- 1, 6 +/- 2, and 5 +/- 1 mmHg to 14 +/- 3, 13 +/- 3, and 10 +/- 4 mmHg, respectively, after exercise. The percent increase (mean) in peak pressure gradient with exercise was significantly higher in group B (more than 100%) than in group A (less than 80%) (p < 0.01). The percent increase in mean gradient with exercise was also significantly higher in group B (more than 100%) than in group A (less than 75%). In conclusion, patients with reduced valve area and more than a 100% increase of peak and mean gradients should be followed up carefully. If any signs or symptoms of heart failure develop, they must be considered as candidates for surgery.
No takes yet. Share an insight, caveat, or question.
Shigenobu et al. (2010) conducted an observational in Asymptomatic patients with a St. Jude Medical mitral valve (n=100). Valves implanted > 5 years ago vs. Valves implanted < 5 years ago was evaluated on Percent increase in peak pressure gradient with exercise (p=< 0.01). Patients with St. Jude mitral valves implanted >5 years ago had a significantly higher percent increase in peak pressure gradient with exercise (>100%) than those <5 years ago (<80%) (p<0.01).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: