P333Limited exercise capacity after valve replacement for aortic stenosis: the impact of reduced right ventricular systolic function

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Background: Surgical aortic valve replacement (AVR) for aortic stenosis (AS) results in depressed right ventricular (RV) systolic function but the relationship between such disturbances and exercise capacity remains unknown.Material and Methods: Exercise capacity and RV systolic function were assessed in 21 AVR patients (age 61±12 years, 14 male) using conventional semi-supine bicycle exercise together with fully equipped Doppler echocardiographic set-up. Peak oxygen consumption (pVO2) as well as conventional and systolic myocardial velocity (Sm) from RV free wall was measured at rest, suboptimal, peak exercise and 4 min after exercise. The data were compared with 21 age and gender matched controls.Results: At rest, patients had normal left ventricular ejection fraction (LVEF). pVO2 at peak exercise was lower in patients than controls (18.5±4.5 vs. 22.1±4.3 l/min/kg, p=0.02). RV Sm was depressed at rest in patients (8.4±1.4 vs. 11.4±2.0 cm/s, p<0.001). During exercise, RV Sm failed to increase as controls (suboptimal exercise: 10.7±2.6 vs. 15.1±2.3; peak exercise: 11.3±2.6 vs. 17.4±2.5 cm/s; 4 minutes after exercise: 9.3±1.9 vs. 13.5±2.8 cm/s. p<0.001 for all).In patients and controls as a whole, pVO2 correlated with RV Sm at rest (r=0.52, p=0.01) and peak exercise (r=0.47, p=0.002).Conclusion: Exercise capacity is subnormal after AVR for AS, irrespective of normal LVEF and lack of symptoms. RV systolic function is reduced after AVR and failed to increase normally during exercise. Finally, it remains an important correlate with the patients' exercise capacity.

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