Mild-to-moderate pulmonary valve stenosis was associated with lower peak VO2 compared to matched controls (31.2 vs 39.0 mL/kg/min; p=0.011), despite preserved right heart function.
Observational (n=19)
Does isolated mild-to-moderate pulmonary valve stenosis reduce exercise capacity and alter haemodynamics during exercise compared to matched controls?
Adult patients with mild-to-moderate pulmonary valve stenosis have decreased exercise capacity compared to controls, despite preserved right ventricular function and a fixed valve area during exercise.
Absolute Event Rate: 31.2% vs 39%
p-value: p=0.011
OBJECTIVE: In adult patients with mild-to-moderate pulmonary valve (PV) stenosis, exercise capacity and haemodynamics have not been extensively studied, although regular exercise is recommended. Therefore, we aimed to assess exercise capacity to study the increase in PV gradient during exercise and to evaluate the impact of this increased pressure load on the RV. METHODS: Nineteen patients (8 female; 29±6.4 years) with isolated mild-to-moderate PV stenosis and no prior cardiac interventions were consecutively enrolled from the outpatient clinic of adult congenital heart disease. All patients underwent cardiopulmonary exercise testing, transthoracic echocardiography and bicycle stress echocardiography. Results for exercise testing were compared with age-matched and gender-matched control patients. RESULTS: In the studied population, resting heart rate (89±11 vs 75±14 bpm; p=0.001), peak power (199±66 vs 263±68 W; p=0.006); peak VO2 (31.2±9.9 vs 39±7.4 mL/kg/min; p=0.011); oxygen uptake efficiency slope (2430±913 vs 3292±943(mL/min)/(L/min); p=0.007) and VE/VCO2 slope (26.8±5.2 vs 22.6±4.3; p=0.01) differed significantly from controls. A linear increase of peak PV gradient with increasing flow was observed in the pooled dataset (Pearson's R=0.947; p<0.0001) and slopes identical as for control patients were obtained for the oxygen pulse-workload relationship. Right heart morphology and function were preserved in the studied patients. CONCLUSIONS: Patients with mild-to-moderate PV stenosis have decreased exercise capacity. A linear increase in PV gradient with flow suggests a fixed valve area throughout the exercise. Although systolic RV pressure load increases during exercise, good ventricular performance was observed without signs of functional or morphological changes of the right heart. CLINICAL TRIAL NUMBER: NCT01444222.
Meester et al. (2014) conducted an observational in Mild-to-moderate pulmonary valve stenosis (n=19). Cardiopulmonary exercise testing and stress echocardiography vs. Age-matched and gender-matched controls was evaluated on Peak VO2 (mL/kg/min) (p=0.011). Mild-to-moderate pulmonary valve stenosis was associated with lower peak VO2 compared to matched controls (31.2 vs 39.0 mL/kg/min; p=0.011), despite preserved right heart function.