Abstract

Exercise testing is underutilized in patients with valve disease. We have previously found a low physical work capacity in patients with aortic regurgitation 6 months after aortic valve replacement (AVR). The aim of this study was to evaluate aerobic capacity in patients 4 years after AVR, to study how their peak oxygen uptake (peakVO2) had changed postoperatively over a longer period of time. Twenty-one patients (all men, 52 ± 13 years) who had previously undergone cardiopulmonary exercise testing (CPET) pre- and 6 months postoperatively underwent maximal exercise testing 49 ± 15 months postoperatively using an electrically braked bicycle ergometer. Breathing gases were analysed and the patients' physical fitness levels categorized according to Åstrand's and Wasserman's classifications. Mean peakVO2 was 22·8 ± 5·1 ml × kg−1 × min−1 at the 49-month follow-up, which was lower than at the 6-month follow-up (25·6 ± 5·8 ml × kg−1 × min−1, P = 0·001). All but one patient presented with a physical fitness level below average using Åstrand's classification, while 13 patients had a low physical capacity according to Wasserman's classification. A significant decrease in peakVO2 was observed from six to 49 months postoperatively, and the decrease was larger than expected from the increased age of the patients. CPET could be helpful in timing aortic valve surgery and for the evaluation of need of physical activity as part of a rehabilitation programme.

Highlights

  • The natural history of chronic aortic regurgitation (AR) is characterized by insidious development and progression (Bekeredjian & Grayburn, 2005)

  • We have previously found a low physical work capacity in patients with aortic regurgitation 6 months after aortic valve replacement (AVR)

  • All but one patient presented with a physical fitness level below average using AstrandÕs classification, while 13 patients had a low physical capacity according to WassermanÕs classification

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Summary

Introduction

The natural history of chronic aortic regurgitation (AR) is characterized by insidious development and progression (Bekeredjian & Grayburn, 2005). While compensatory mechanisms within the heart limit symptoms, simultaneously the development of irreversible fibrotic changes of the heart muscle may be disguised (Bekeredjian & Grayburn, 2005). According to current recommendations (Bonow et al, 2006; Vahanian et al, 2007), aortic valve replacement (AVR) is indicated when symptoms have occurred, and may be considered in asymptomatic patients with severe regurgitation. Echocardiography is the predominant method for the evaluation of these patients (Bonow et al, 2006; Katz & Devereux, 2000; Vahanian et al, 2007). Knowledge is limited concerning changes in peakVO2 following AVR in patients with chronic AR

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