楠瀬 賢也, 山田 博胤, 佐田 政隆

Kenya KUSUNOSE, Hirotsugu YAMADA, Masataka SATA

徳島大学病院循環器内科

Cardiovascular Medicine, Tokushima University Hospital

キーワード :

Background: The decision-making role of exercise echocardiography in the surgical timing for valvular heart disease including mitral（MR）and aortic regurgitation（AR）remains a matter of debate because of limited data on its link with outcome. The aim of this study was to assess the role of right ventricular（RV）measures at rest and during exercise as predictors of prognosis in asymptomatic MR and AR.
Methods: Comprehensive resting and exercise echocardiography was performed in 196 MR patients（56±13 years; 64％male）and 159 AR patients（50±15 years; 80％male）with preserved left ventricular（LV）function according to the recent guideline. LV and RV longitudinal strain were analyzed at rest using velocity vector imaging. Tricuspid annular plane systolic excursion（TAPSE）and systolic pulmonary arterial pressure（sPAP）were measured at rest and during exercise.
Results: Patients were followed in accordance with current guidelines（clinical follow-up visits every 6 to 12 months and echocardiography annually）, with the end points of valve surgery. In both MR and AR groups, after adjustment for age and sex in a Cox proportional-hazards model, exercise TAPSE, was associated with valve surgery-free survival, independent of resting LV strain, resting RV strain and exercise sPAP.
Conclusions: In asymptomatic MR and AR, exercise TAPSE and exercise SPAP were independently associated with the need for earlier valve surgery.
References
1）Nishimura RA, et al. 2014 aha/acc guideline for the management of patients with valvular heart disease: Executive summary: A report of the american college of cardiology/american heart association task force on practice guidelines. J Am Coll Cardiol. 2014;63:2438-2488.
2）Kusunose K et al. Prognostic Significance of Exercise-induced Right Ventricular Dysfunction in Asymptomatic Degenerative Mitral Regurgitation. Circ Cardiovasc Imaging. 2013;6:167-76.
3）Kusunose K et al. Decision-making in Asymptomatic Aortic Regurgitation in the Era of Guidelines: Incremental Values of Resting and Exercise Cardiac Dysfunction. Circ Cardiovasc Imaging. 2014; 7: 352-362.