Usefulness of mean aortic valve gradient and left ventricular diastolic filling pattern for distinguishing symptomatic from asymptomatic patients

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Abstract

Consecutive, symptomatic (n = 15) and asymptomatic (n = 25) men with aortic stenosis (valve area <1.2 cm2) and no clinical evidence of myocardial ischemia underwent radionuclide angiography at rest and during supine bicycle ergometry. Ejection fraction, diastolic filling pattern and aortic valve area/gradient were measured on enrollment and when patients became symptomatic (n = 10) or underwent valve replacement (n = 22) during a 2-year follow-up period. Both groups had similar heart rate, blood pressure and ejection fractions, but mean aortic gradients were higher in symptomatic (53 ± 4 mm Hg) than asymptomatic (37 ± 2 mm Hg) subjects p < 0.01. Functional limitation evoked by exercise was prevalent even in the asymptomatic group but symptomatic patients exercised to lower work levels than asymptomatic subjects (184 ± 27 and 307 ± 32 kg · m/min, respectively, p = 0.02). Ejection fraction failed to increase with exercise in either group. Symptomatic subjects had supranormalization of early diastolic filling with shorter time to the peak filling rate than asymptomatic subjects (137 ± 16 and 172 ± 9 ms, respectively, p < 0.05) and a greater first 13 filling fraction. The 10 patients who became symptomatic during follow-up had higher first 13 filling fractions (53 ± 7 and 42 ± 5%, respectively) and mean gradients (41 ± 4 and 33 ± 2 mm Hg, respectively) than subjects who remained asymptomatic, p < 0.05. High mean aortic gradients, impaired exercise tolerance and enhanced early diastolic filling distinguish symptomatic from asymptomatic patients.

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Dr. Archer is supported by the Veterans Administration and the Minnesota Medical Foundation and Grant 1R29-HL45735-1 from the National Institutes of Health, Bethesda, Maryland.

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