Key result
Percutaneous balloon valvuloplasty in patients with tight mitral stenosis significantly increased peak exercise oxygen uptake (P<0.01), cardiac output (P<0.001), and lung diffusing capacity (P<0.05).
Why the study?
Does percutaneous transvenous balloon valvuloplasty improve lung diffusing capacity and exercise tolerance in patients with tight mitral stenosis?
Observational (n=16)
Does percutaneous transvenous balloon valvuloplasty improve lung diffusing capacity and exercise tolerance in patients with tight mitral stenosis?
Percutaneous balloon valvuloplasty improves exercise tolerance in patients with tight mitral stenosis, partially by restoring normal lung diffusing capacity dynamics during exercise recovery.
May improve exercise tolerance in tight mitral stenosis; leaves open need for randomized confirmation of lung diffusing capacity effects.
The aim of this study was to specify in patients with tight mitral stenosis whether lung diffusing capacity could play a role in their exercise intolerance. A similar study was recently carried out in patients with moderate chronic heart failure. Ten patients with tight mitral stenosis were studied before and 6 months after successful percutaneous transvenous balloon valvuloplasty and compared to six control subjects. Measurements of diffusing capacity, evaluated by the lung transfer factor (TLCO) and by the transfer coefficient (TLCO/VA), obtained at rest and during early recovery after cardiopulmonary exercise testing were performed. Cardiac output was determined non-invasively, both at rest and during exercise, using the carbon dioxide exponential rebreathing technique. Prior to valvuloplasty, TLCO and TLCO/VA were not different at rest between the two groups. During exercise, patients differed from control subjects, with lower oxygen uptake (P < 0.001) and lower cardiac output at peak exercise (P < 0.001). These values at peak exercise were significantly correlated (P = 0.02; r = 0.75). Moreover, patients differed from control subjects at early recovery after peak exercise with an absence of increase in TLCO (P < 0.05). Six months after valvuloplasty, a decrease of both TLCO (P < 0.01) and TLCO/VA (P < 0.05) was observed at rest. During exercise, comparison of patients demonstrated a significant increase of both peak exercise oxygen uptake (SLVO2, P < 0.01) and cardiac output (P < 0.001). At early recovery after peak exercise there was a significant increase in TLCO (P < 0.05) and TLCO/VA (P < 0.01), such that a delta TLCO and a delta TLCO/VA appeared (P < 0.05) identical to that observed in control subjects. Moreover, delta SLVO2 was significantly correlated in patients with delta Q+ delta TLCO/VA (P = 0.02; r = 0.72). In conclusion, this study suggests a role, at least partial, of lung diffusing capacity in exercise intolerance in patients with tight mitral stenosis and in the improvement of their aerobic exercise capacity demonstrated after successful percutaneous balloon valvuloplasty.
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Messner-Pellenc et al. (1996) conducted an observational in Tight mitral stenosis (n=16). Percutaneous transvenous balloon valvuloplasty vs. Control subjects and pre-valvuloplasty baseline was evaluated on Lung diffusing capacity (TLCO) and exercise tolerance (oxygen uptake and cardiac output) (p=<0.05). Percutaneous balloon valvuloplasty in patients with tight mitral stenosis significantly increased peak exercise oxygen uptake (P<0.01), cardiac output (P<0.001), and lung diffusing capacity (P<0.05).
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