ROLE OF STRESS ECHOCARDIOGRAPHY IN THE FUNCTIONAL ASSESSEMENT OF PROSTHETIC MITRAL VALVE

  • Dr.P.S.CHAKKARAVARTHI Asst. Professor, Department of Cardiology, Govt. Thiruvarur Medical College, Thiruvarur- 610 004.
    sibichakru@gmail.com

Abstract

Objective: To assess the resting echo profile of patients with prosthetic mitral valve and monitor the function of the prosthetic valves by doing stress echocardiography by treadmill exercise and dobutamine infusion.


Methods: An open-labeled prospective randomized comparative study was conducted in  30 patients at Madras Medical  College and Hospital, Chennai- 600 003, Tamil Nadu. Patients, who have been done mitral valve replacement, were selected randomly to undergo the stress echocardiography. 14 male and 16 female patients were included and evaluated on the basis of Echocardiographic examination, Exercise studies, Dobutamine stress echocardiography & Estimation of LV outflow.      


Results: Upon comparison, the patient's heart rate were increased from rest to exercise by a mean of 24 ±12.5 beats per minute. The paired t-test showed a significant correlation with an increase in the dobutamine group (P <0.001). With respect to peak gradients, it was increased between the two stress protocols was statistically significant (P <0.001). The mean gradient obtained at rest and with exercise and dobutamine stress also showed a similar pattern of increase as seen in the peak gradient. Moreover,  the net difference in the Pulmonary artery pressure achieved with both stress protocols was 5.563±4.6mmHg more in the exercise protocol which was statistically significant  (P <0.001).


Conclusion: The study reveals Dobutamine produces a greater augmentation in the effective mitral orifice area when compared to exercise. Similarly, the exercise protocol produces a much higher increase in the pressure gradients when compared with dobutamine.

Keywords: Valvular heart diseases, Stress Echo, Exercise, Dobutamine

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References

Dhoble A, Sarano ME, Kopecky SL, et al: Safety of symptom-limited cardiopulmonary exercise testing in patients with aortic stenosis. Am J Med 2012; 125: 704–708.

Lancellotti P, Magne J: Stress echocardiography in regurgitant valve disease. Circ Cardiovasc Imaging 2013; 6: 840–849.

Lin SS, Roger VL, Pascoe R, et al: Dobutamine stress Doppler hemodynamics in patients with aortic stenosis: feasibility, safety, and surgical correlations. Am Heart J 1998; 136: 1010–1016.

Van Le D, Jensen GV, Carstensen S, et al: Cardiopulmonary exercise testing in patients with asymptomatic or equivocal symptomatic aortic stenosis: feasibility, reproducibility, safety and information obtained on exercise physiology. Cardiology 2016; 133: 147–156.

Pierard LA, Lancellotti P: Stress testing in valve disease. Heart 2007; 93: 766–772.

Nishimura RA, Otto CM, Bonow RO, et al: 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/ American Heart Association Task Force on Practice Guidelines. J Thorac Cardiovasc Surg 2014; 148:e1–e132.

Vahanian A, Alfieri O, Andreotti F, et al: Guidelines on the management of valvular heart disease (version 2012). The Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC) and the European Association for Cardio- Thoracic Surgery (EACTS) (in Italian). G Ital Cardiol (Rome) 2013; 14: 167–214.

Lancellotti P, Pellikka PA, Budts W, et al: The clinical use of stress echocardiography in non-ischaemic heart disease: recommendations from the European Association of Cardiovascular Imaging and the American Society of Echocardiography. Eur Heart J Cardiovasc Imaging 2016; 17: 1191–1229.

Hobson NA, Wilkinson GA, Wheeldon NM, et al., Hemodynamic performance of the Ultracor and Carpentier – Edwards aortic prostheses using exercise and dobutamine stress echocardiography; Heart Valve Dis.2005 Nov;14(6):828-34.

Braunwald’s Heart Disease – A Textbook of Cardiovascular Medicine 9th Edition; 168 – 170, 240 – 244.

Tatineni S, Barner HB, Pearson AC, Halbe D, Woodruff R, Rest and exercise evaluation of St. Jude Medical and Medtronic Hall prostheses. Influence of primary lesion, valvular type, valvular size, and left ventricular function. Circulation. 1989 Sep;80(3 Pt 1):I16-23.

Hobson NA, Wilkinson GA, Wheeldon NM, et al., Hemodynamic performance of the Ultracor and Carpentier – Edwards aortic prostheses using exercise and dobutamine stress echocardiography. J Heart Valve Dis.2005 Nov;14(6):828-34.
Shimon A. Reisner, MD., et al., Exercise Doppler echocardiography in patients with mitral prosthetic valves., American Heart Journal,Volume 118, Issue 4, October 1989, 755– 759.

Dressler FA & Labovitz AJ. Exercise evaluation of prosthetic heart valves by Doppler echocardiography: comparison with catheterization studies; Echocardiography. 1992 Mar;9(2):235-41.

Kadir I, Walsh C, Wilde P, Bryan AJ, et al., Comparison of exercise and dobutamine echocardiography in the hemodynamic assessement of small size mechanical aortic valve prostheses. Eur J Cardiothorac Surg.2002Apr;21(4):692-7.

Eugenio P,Philippe P, Parizio L. The Emerging Role of Exercise Testing and Stress Echocardiography in Valvular Heart Disease.J Am Coll Cardiol.2009;54(24):2251-2260.

Neil A.H, Glen A.L, Wilkinson, Graham J, et al., Hemodynamic Assessment of Mitral Mechanical Prostheses under High Flow Conditions: Comparison between Dynamic Exercise and Dobutamine Stress. J Heart ValveDis Jan2006 Vol 15.No1 87-92

Jeffrey I.L, Mary H C,Rodney H.F., Effects of Exercise on Transmitral Gradient and Pulmonary Artery Pressure in patients with Mitral Stenosis or a Prosthetic Mitral Valve:A Doppler Echocardiographic Study; Journal of the American Society of Echocardiography 1991;1520-6.

Eugenio Picano, Philippe Pibarot, Patrizio Lancellotti; The Emerging Role of Exercise Testing and Stress Echocardiography in Valvular Heart Disease. J Am Coll Cardiol.2009;54(24): 2251-2260.

Zabalgoitia M, Kopec K Oneschuk, L Linn, W Herrera CJ, et al., A Use of dobutamine stress echocardiography in assessing mechanical aortic prostheses: comparison with exercise echocardiography;; J Heart Valve Dis.1997 May; ;6(3):253-7

Mertes H, Sawada SG, Ryaan T, et al., Symptoms, adverse effects, and complications associated with dobutamine stress echocardiography.Experience in 1118 patients; Circulation .1993 Jul;88(1):15-9.
Published
08-04-2021
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Dr.P.S.CHAKKARAVARTHI. “ROLE OF STRESS ECHOCARDIOGRAPHY IN THE FUNCTIONAL ASSESSEMENT OF PROSTHETIC MITRAL VALVE”. World Journal of Current Medical and Pharmaceutical Research, Apr. 2021, pp. 13-20, doi:10.37022/wjcmpr.vi.169.
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Research Articles