PMID- 16585393
OWN - NLM
STAT- MEDLINE
DCOM- 20060518
LR  - 20151119
IS  - 1524-4539 (Electronic)
IS  - 0009-7322 (Linking)
VI  - 113
IP  - 14
DP  - 2006 Apr 11
TI  - Influence of preoperative left ventricular contractile reserve on postoperative 
      ejection fraction in low-gradient aortic stenosis.
PG  - 1738-44
AB  - BACKGROUND: Dobutamine stress hemodynamics (DSH) has the potential to stratify 
      operative risk in low-gradient aortic stenosis (AS), but little is known about 
      the relation between left ventricle contractile reserve and postoperative left 
      ventricular ejection fraction (LVEF). We sought to assess the value of DSH to 
      predict postoperative improvement in LVEF. METHODS AND RESULTS: Sixty-six 
      consecutive patients with symptomatic severe AS (aortic valve area < or =1 cm2), 
      LVEF < or =40%, and mean pressure gradient < or =40 mm Hg prospectively enrolled 
      in the French multicenter study on low-gradient AS and who survived to aortic 
      valvular replacement (AVR) were included. Preoperative contractile reserve was 
      present in 46 patients (group I; 70%) and absent in 20 patients (group II; 30%). 
      In the overall sample, 58% of patients improved by 2 New York Heart Association 
      (NYHA) classes after AVR. Mean LVEF improved from 29+/-6% to 47+/-11% (P<0.0001). 
      LVEF improved by > or =10 EF units in 38 patients (83%) in group I and in 13 
      patients (65%) in group II. Mean LVEF improvement was similar in the 2 groups 
      (19+/-10% versus 17+/-11%; P=0.54). On multivariable analysis, multivessel 
      coronary artery disease (P=0.05) and baseline mean transaortic pressure gradient 
      (P=0.01) were related to LVEF improvement, whereas contractile reserve was not. 
      CONCLUSIONS: LVEF increases in the majority of patients with low-gradient AS who 
      survive after AVR. Although the absence of contractile reserve on DSH is related 
      to high operative mortality, it does not predict the absence of LVEF recovery in 
      patients surviving to AVR. These data further support the concept that surgery 
      should not be contraindicated on the basis of absence of contractile reserve 
      alone.
FAU - Quere, Jean-Paul
AU  - Quere JP
AD  - Department of Cardiology, INSERM, ERI-12, University Hospital, Amiens, France.
FAU - Monin, Jean-Luc
AU  - Monin JL
FAU - Levy, Franck
AU  - Levy F
FAU - Petit, Helene
AU  - Petit H
FAU - Baleynaud, Serge
AU  - Baleynaud S
FAU - Chauvel, Christophe
AU  - Chauvel C
FAU - Pop, Camelia
AU  - Pop C
FAU - Ohlmann, Patrick
AU  - Ohlmann P
FAU - Lelguen, Claude
AU  - Lelguen C
FAU - Dehant, Patrick
AU  - Dehant P
FAU - Gueret, Pascal
AU  - Gueret P
FAU - Tribouilloy, Christophe
AU  - Tribouilloy C
LA  - eng
PT  - Journal Article
DEP - 20060403
PL  - United States
TA  - Circulation
JT  - Circulation
JID - 0147763
RN  - 3S12J47372 (Dobutamine)
SB  - IM
CIN - Circulation. 2006 Apr 11;113(14):1718-20. PMID: 16606799
MH  - Aged
MH  - Aortic Valve/*surgery
MH  - Aortic Valve Stenosis/*surgery
MH  - Dobutamine
MH  - Echocardiography
MH  - Female
MH  - Heart Valve Prosthesis Implantation/mortality
MH  - Hemodynamics
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Myocardial Contraction
MH  - Postoperative Period
MH  - Survival Analysis
MH  - Ventricular Dysfunction, Left/*physiopathology
MH  - Ventricular Function, Left/*physiology
EDAT- 2006/04/06 09:00
MHDA- 2006/05/19 09:00
CRDT- 2006/04/06 09:00
PHST- 2006/04/06 09:00 [pubmed]
PHST- 2006/05/19 09:00 [medline]
PHST- 2006/04/06 09:00 [entrez]
AID - CIRCULATIONAHA.105.568824 [pii]
AID - 10.1161/CIRCULATIONAHA.105.568824 [doi]
PST - ppublish
SO  - Circulation. 2006 Apr 11;113(14):1738-44. doi: 10.1161/CIRCULATIONAHA.105.568824. 
      Epub 2006 Apr 3.