Abstract
Background
The impact of prosthesis-patient mismatch (PPM) after aortic valve replacement (AVR)
for aortic stenosis on exercise capacity remains controversial. The aim of this study
was to analyze the long-term impact of PPM after mechanical AVR on maximal oxygen
uptake (VO2max).
Methods
The study included 75 patients who had undergone isolated mechanical AVR for aortic
stenosis with normal left ventricular (LV) function between 1994 and 2012. Their functional
capacity was evaluated on average 4.6 years after AVR by exercise testing, including
measurement of their VO2max, and by determining their New York Heart Association functional class and Short Form-36
score. Two groups were defined by measuring the patients' indexed effective orifice
area (iEOA) by transthoracic echocardiography: a PPM group (iEOA < 0.85 cm2/m2) and a no-PPM group (iEOA ≥ 0.85 cm2/m2).
Results
PPM was present in 37.0% of the patients. The percentage of the predicted VO2max achieved was significantly lower in the PPM group (86.7 ± 19.5% vs 97.5 ± 23.0% in
the no-PPM group; P = 0.04). Compared with the no-PPM group, the PPM group contained fewer patients in
New York Heart Association functional class I and their mean Short Form-36 physical
component summary score was significantly lower. The mean transvalvular gradient was
significantly higher in the PPM group than in the no-PPM group (P < 0.001). Systolic and diastolic function and LV mass had normalized in both groups.
Conclusions
PPM is associated in the long term with moderate but significant impairment of functional
capacity, despite optimal LV reverse remodelling and normalization of LV systolic
and diastolic function.
Résumé
Introduction
Les répercussions de la disproportion patient-prothèse (DPP) sur la capacité à l’effort
après le remplacement valvulaire aortique (RVA) pour une sténose aortique demeurent
controversées. L’objectif de cette étude était d’analyser les conséquences à long
terme de la DPP après le RVA par prothèse mécanique sur la consommation maximale d’oxygène
(VO2 max).
Méthodes
L’étude comptait 75 patients qui avaient subi le RVA isolé par prothèse mécanique
pour une sténose aortique associée à une fonction normale du ventricule gauche (VG)
entre 1994 et 2012. Leur capacité fonctionnelle était évaluée sur une période moyenne
de 4,6 ans après le RVA par une épreuve à l’effort, dont la mesure de leur VO2 max, et la détermination de leur classification fonctionnelle selon le New York Heart
Association et leur score au questionnaire SF-36 (Short Form-36). Deux groupes étaient
définis par la mesure par échocardiographie transthoracique de la surface fonctionnelle
de l’orifice indexée (SFOi) des patients: un groupe DPP (SFOi < 0,85 cm2/m2) et un groupe non-DPP (iEOA ≥ 0,85 cm2/m2).
Résultats
La DPP était présente chez 37,0 % des patients. Le pourcentage de prédiction de l’atteinte
de la VO2 max était significativement plus faible dans le groupe DPP (86,7 ± 19,5 % vs 97,5 ± 23,0 % dans le groupe non-DPP; P = 0,04). Comparativement au groupe non-DPP, le groupe DPP qui comprenait moins de
patients de la classification fonctionnelle I de la New York Heart Association obtenait
un score moyen au sommaire de la composante physique du questionnaire SF-36 significativement
plus faible. Le gradient transvalvulaire moyen était significativement plus élevé
dans le groupe DPP que dans le groupe non-DPP (P < 0,001). Les fonction systolique et diastolique et la masse VG s’étaient normalisées
dans les 2 groupes.
Conclusions
La DPP est associée à long terme à la détérioration modérée, mais significative, de
la capacité fonctionnelle, en dépit du remodelage inverse optimal du VG et de la normalisation
des fonctions systolique et diastolique du VG.
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Article info
Publication history
Published online: March 08, 2016
Accepted:
February 20,
2016
Received:
October 29,
2015
Footnotes
See page 1498 for disclosure information.
Identification
Copyright
© 2016 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
