I have an acute myocardial infarction: open my coronary artery, stent it and keep full flow!
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Angioplasty, Balloon, Coronary↗
Biomedical subjects
M Aschermann
Publications and source records attributed to M Aschermann.
[Direct percutaneous transluminal coronary angioplasty in patients with acute myocardial infarct treated at the Cardiac Center of the General Medical School Hospital in Prague: a 1-year retrospective study].
UNLABELLED: Direct percutaneous transluminal coronary angioplasty (d-PTCA) in patients with acute myocardial infarctions (AIM) has become an alternative of thrombolytic treatment. If the involved department has adequate experience the success rate of the procedure is high and the immediate and long-term results are better than those of thrombolysis. Moreover contrary to thrombolytic treatment successful percutaneous coronary intervention in AIM is more beneficial for patients also later than 6 hours after the development of infarction pain. In the Cardiocentre of the General Faculty Hospital (GFH) patients with AIM are constantly attended, i.e. those indicated for reperfusion therapy are treated solely by the d-PTCA method. OBJECTIVE AND METHOD: Retrospective analysis of d-PTCA in AIM made during the annual period from Jan. 1 2000 to Dec. 31 2000. Into the observation study patients were included with clinical and/or ECG signs of AIM when the period from the onset of pain to the beginning of intervention did not exceed 12 hours. All patients were given before the procedures 500 mg of acetylsalicylic acid and 10,000 u. heparin. Cardiac catheterization was implemented by the percutaneous Seldinger technique via the a. femoralis l.dx., in exceptional cases from the left femoral artery. An approach via the a. radialis and/or a. brachialis was not used in any of the patients. From the investigation patients were excluded who had before the percutaneous coronary intervention (PCI) a thrombolytic preparation (so-called rescue-PTCA). RESULTS: During the mentioned period in the Cardiocentre of the GFH a total of 673 PTCA were performed, incl. 127 (18.9%) d-PTCA in patients with AIM. In the mentioned group of 127 patients subjected to intervention were 87 (68.5%) men and 40 (31.5%) women. The mean age of the men was 59.1 +/- 12 years and the mean age of the women 68.2 +/- 12 years. As to the main risk factors of coronary atherosclerosis arterial hypertension was present in 48%, smoking in 42%, diabetes in 23% and hyperlipoproteinaemia in 31% of the treated patients. More than one third of the patients had a history of myocardial infarction (38%). The infarcted artery was the r. interventricularis anterior (LAD) in 51 (40.2%), the right coronary artery (RCA) in 54 (42.5%), the r. circumflex (LCX) in 16 (12.6%), the left main coronary artery in 2 (1.6%) and the bypass in 4 (3.1%). Multiple coronary affections were recorded in 80 (63%) patients, affections of one artery in 47 (37%). Primary procedural success (flow TIMI 3/2) was achieved in 121 patients (95.3%). Normal flow through the infarcted artery TIMI 3 was achieved in 118/127 (85.8%) patients. In 91 (71.7%) into the infarcted artery a coronary stent was implanted, during hospitalization no subacute stenosis of the stent developed. The mean period between the onset of infarction pain--injection was 4.4 +/- 2.3 hours. The mean period of the entire procedures was 48 +/- 14.5 minutes. As contrast material only non-ionic contrast substances were used (Iomeron 350) with a mean consumption of 150 ml per patient. The mean skiascopic time was 13.6 +/- 1.8 min. A total of 9 (7.1%) patients were treated with GP IIb/IIIa receptor blockers (abciximab). The total hospitalization mortality of the intervened group was 7.1% (9 patients). In a sub-group of 9 patients who at the onset of the procedure were in cardiogenic shock 3 (33%) died. The hospitalization mortality of the sub-group of patients with AIM without cardiogenic shock, treated with d-PTCA was 5.1% (6/118). During hospitalization the authors did not observe any intracranial haemorrhage. DISCUSSION: The group of subjects with AIM subjected to catheterization who are treated by d-PTCA is relatively numerous in our department. According to a number of clinical studies successful d-PTCA in AIM gives better short-term and long-term results as compared with thrombolytic therapy. The primary success rate of d-PTCA was high and the hospital mortality was low and comparable with contemporary data in the literature. CONCLUSION: Direct PTCA is effective treatment in patients with acute myocardial infarction. The authors results confirm the high procedural success rate and acceptable hospital mortality. These favourable results of an invasive approach to treatment of AIM must be compared in future with bolus thrombolytic treatment by new types of thrombolytic preparations in combination with anti-platelet treatment with blockers of platelet glycoprotein receptors IIb/IIIa with/or without subsequent percutaneous coronary intervention.
Aged↗
[Acetylsalicylic acid and ACE inhibitors in heart disease--a phenomenon in dogs and cats?].
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Angiotensin-Converting Enzyme Inhibitors↗
[Is mild essential hypertension without obvious organ complications and risk factors associated with increased levels of circulating markers of endothelial dysfunction? Effect of ACE inhibitor therapy].
The objective of the investigation was to assess whether circulating adhesion molecules, von Willebrand factor (vWf) and endothelin-1 are elevated in patients with mild uncomplicated essential hypertension without further risk factors of atherosclerosis and whether they could serve as indicators of endothelial dysfunction in this form of hypertension. Furthermore the authors investigated the effect of ACE inhibitor treatment (ACEI), quinapril, on the level of these markers of endothelial dysfunction. The level of adhesion molecules [intercellular cytoadhesion molecule-1 (ICAM-1), E-selectin, P-selectin], von Willebrand s factor (vWf) and endothelin-1 were assessed in patients with mild essential hypertension without further cardiovascular risk factors or clinical manifestations of atherosclerosis before and after quinapril treatment (n = 25) and compared with normotensive controls (n = 29). The results of the examinations provided evidence that contrary to controls the hypertensive subjects had significantly higher ICAM-1 levels (237.8 vs. 207.8 ng/ml, P = 0.02) vWf (118 vs. 106 IU/dl, p < 0.05) and endothelin-1 (5.81 vs. 5.15 fmol/ml, p < 0.05). Three-month treatment of hypertensive patients with ACEI led to a significant drop of endothelin-1 levels (5.81 vs. 5.26 fmol/ml, p = 0.01). The authors proved also an unequivocal declining trend of other cytoadhesion molecules and vWf after ACEI treatment, the changes however were not statistically significant. From the investigation it may be concluded that also patients with uncomplicated essential hypertension without other cardiovascular risk factors or clinical manifestations of atherosclerosis have significantly elevated plasma levels of ICAM-1, vWf and endothelin-1. Higher concentrations of these factors suggest endothelial dysfunction already in mild forms of essential hypertension without further risk factors or cardiovascular complications. A significant drop of endothelin-1 and declining trend of the other investigated indicators suggest that ACEI treatment can favourably influence endothelial dysfunction in hypertensive patients also independently on reduction of the BP.
Angiotensin-Converting Enzyme Inhibitors↗
[The beginnings of electrocardiography at the Prague Medical School].
The authors describe the beginnings of development of electrocardiography at the Prague Medical Faculty of Charles-Ferdinand and Charles University resp. The first results of the new method came from the physiological laboratory of Ewald Karl Konstantin Hering (1834-1918), who contributed to electrocardiography by explaining the mechanism of atrial fibrillation and to Richard Hans Kahn (1876-1941) who was the first to publish electrocardiographic changes after temporary block of coronary artery blood flow in the dog. Clinical application and the promotion of electrocardiography in this country is among others in particular from Václav Libenský (1877-1938), Klement Weber (1890-1971) and Frantisek Herles (1900-1991) whose name became for half a century the synonym for electrocardiography.
Czech Republic↗
[ECG mapping in clinical practice].
First the authors present a review of important cornerstones in the history of the electrocardiogram (ECG) and ECG mapping. The first to describe the electric cardiac field based on twenty ECGs was A.D. Waller in 1889. The decisive cornerstone for practical use was the introduction of a string galvanometer in 1901 by W. Einthoven and his triaxial lead system. Another very important cornerstone in the development of ECG were the findings of F.N. Wilson. Merits as regards the development and application of ECG mapping are due to B. Taccardi. Workers of the Second Medical Clinic in Prague enhanced after 15 years of studies and comparison of ECG maps with coronarographic findings in subjects with ischaemic heart disease (IHD) and microvascular coronary dysfunction (syndrome X--SyX) substantially the specificity of this method in impaired myocardial vascularization. Better diagnosis was achieved by introduction of diagnostic tests which influence coronary vascularization such as e.g. hyperventilation, as well as other tests. After their application progression of chronic myocardial ischaemia occurs, e.g. by the mechanism of the "steal phenomenon" or restriction of the microcirculation after hyperventilation in patients with SyX. Furthermore the authors present examples of ECG maps after PTCA, after application of diagnostic tests in IHD and SyX and also regression of myocardial ischaemia after marked reduction of total cholesterol.
Adult↗
Cardiac manifestations in Fabry disease.
Fabry disease is an X-linked recessive genetic disorder of glycosphingolipid metabolism, due to deficiency of the lysosomal enzyme alpha-galactosidase A. The disease is characterized by the progressive intracellular lysosomal accumulation of neutral glycosphingolipids throughout the body, including the cardiovascular system. It has been reported that cardiac involvement could be the sole manifestation of the disease in some patients. Myocardial abnormalities are characterized mainly by left ventricular (LV) wall thickening without significant cavity dilatation, the most frequent abnormal structural pattern being concentric LV hypertrophy (LVH). In some patients the disease mimics a typical hypertrophic obstructive cardiomyopathy. According to our experience, systolic function is largely preserved in a large majority of affected individuals. In contrast, mild to moderate impairment of diastolic filling is a relatively common finding, representing probably the most important cause of dyspnoea in patients with Fabry disease. However, in a relatively large population of affected patients, severe diastolic dysfunction, typical of restrictive cardiomyopathy, was not found. Valvular structural abnormalities are frequent due to valvular infiltration. In several patients, hypertrophy of papillary muscles and/or systolic anterior motion of the mitral leaflets associated with LV outflow obstruction may aggravate the mitral valve dysfunction. We did not confirm the previously reported high prevalence of mitral valve prolapse. Valvular regurgitation seems to be relatively frequent but mostly non-significant. Electrocardiographic changes in Fabry disease are multiple and include atrioventricular (AV) conduction abnormalities (abbreviation of the P-R interval or AV blocks), signs of LVH and repolarization abnormalities. Our observations suggest that conduction defects and repolarization changes are present predominantly in subjects with LV structural abnormalities. Cardiac symptoms in patients with Fabry disease include shortness of breath on effort (related to LV diastolic dysfunction), vasospastic and/or exertional angina pectoris (due to LVH, endothelial dysfunction and/or fixed coronary artery stenosis) and syncope (related to AV blocks or LV outflow obstruction). The extent of cardiac involvement, in particular LV mass assessment, could represent an ideal surrogate endpoint for evaluating the efficacy of specific therapies.
Electrocardiography↗
[Takayasu's disease associated with autoimmune thyroiditis and celiac disease. Clinical course and limitations of treatment].
Takayasu's arteritis is a non-specific form of vasculitis involving the aorta, its main branches and pulmonary arteries. It is a rare disease in our country, contrasting with the high prevalence in Southeast Asia, Africa and South America. We discuss the course of the disease in our patient who was a young women who developed Takayasu's arteritis associated with autoimmune thyroiditis and malabsorption syndrome due to celiac sprue. Long-term immunosuppressive therapy contributed to stabilizing the associated diseases, but did not stop the progression of the vascular lesions. The main adverse outcome in our patient was the development of severe renovascular hypertension. Bilateral renal artery stenosis was treated by angioplasty with stent implantation. Based on literature reports, the association of Takayasu's disease with multiple autoimmune disorders is a rare event. However, it would appear that the arteritis was the limiting disease for prognosis in our patient.
Celiac Disease↗
[Complications in administration of contrast media in the catheterization laboratory: a 5-year retrospective study].
UNLABELLED: Iodine contrast substances (CS) are used since the twenties of the 20th century. From the chemical aspect benzoic acid derivatives are involved which are classified according to their osmolality (high-low- and isoosmolar) tendency of ionization (ionic and non-ionic) and according to the molecular structure monomers and dimers). Side-effects are due to their osmotic, ionic and chemical action on tissues. They include a number of systemic and organ symptoms (cardiovascular, immunological, haemocoagulation, neurological and renal), from the clinical aspect divided into mild, medium severe and severe. The relatively high incidence of undesirable reactions when ionic high-molecular CS are used led to the-development of non-ionic preparations with a lower osmolality, the more extensive use of which is limited by economic factors. Moreover so far convincing clinical data are lacking that the higher incidence of undesirable reactions after the use of CS has a clinical impact. OBJECTIVE: To summarize experience with administration of CS in the catheterization laboratory of the Cardiocentre of the General Faculty Hospital during diagnostic and intervention procedures within 5 years with regard to the occurrence of undesirable effects when comparing ionic and non-ionic CS. METHOD: Retrospective analysis of a group of patients examined in the catheterization laboratory to whom a CS was administered during the period between Jan. 1 1995 and Dec. 31 1999. RESULTS: In 1995-1999 (5 years) in the catheterization laboratory a total of 10,149 procedures where implemented where ionic (ioxitalam-Telebrix 350) and non-ionic (iopromide Ultravist 370, ioversol--Optiray 370 and iomeprol-Iomeron 350) contrast substances were administered. Ionic CS were administered in 4,668 (46%) and non-ionic CS in 5,481 (54%) instances. Undesirable effects were recorded in a total of 107 (1.1%) patients, incl. ventricular fibrillation in 76 (0.75%), cardiac arrest in 12 (0.12%) and in 19 (0.19%) there were other undesirable effects (weakness, nausea, hypotension, flush, urtica etc.). Ionic and non-ionic CS participated equally in complications: ionic CS in 53 (49.5%) cases and non-ionic CS in 54 (50.5%), whereby no difference was observed in the type of complications. No death in conjucntion with administration of CS was observed. CONCLUSION: The use of contemporary contrast substances in the catheterization laboratory for diagnostic and intervention procedures on the heart is relatively safe with a minimal risk of development of serious complications. No difference was observed between the use of ionic and non-ionic CS.
Cardiac Catheterization↗
[Thromboembolic complications in the use of oral estrogen-gestagen contraceptives].
Deep vein thrombosis is a serious complication of oral contraception. The most serious complication, pulmonary embolism, could be lethal. The relative risk of thromboembolic disease is four time higher in women using oral contraception. Both the amount of estrogen and the type of gestagen can increase the relative risk of thromboembolic disease. Oral contraceptives influence procoagulants, fibrinolytic system and inhibitors of coagulation. The choice of oral contraceptive should be very careful. It is advised to use preparations with less then 50 micrograms of ethinyl-estradiol and the type of gestagen that has minimal metabolic side effects, including minimal effect on coagulation. It is not recommended to perform screening of trombophilia before prescribing oral contraception. Family history of thrombosis is indication for more detailed investigation. However in the case of positive history of thromboembolic disease use of oral contraception is contraindicated. Oral contraception users should be informed about increased risk of deep vein trombosis, and what to do to prevent deep vein thrombosis.
Blood Coagulation↗
[New aspects of the algorithm used for examination of patients with probable unstable angina pectoris or non-Q myocardial infarction].
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Algorithms↗
[Occurrence of reflux esophagitis in patients with chest pain and a normal selective coronary angiogram].
BACKGROUND: Chest pains are related to coronary disease, and to several other disorders, among which the most commons are the oesophageal diseases. The aim of the work was the identification of the reflux oesophagitis in patients with chest pain and normal selective coronary angiogram. METHODS AND RESULTS: In the examined group 65 patients (42 females, 23 males) of the average age 55.2 years were included. All of them underwent endoscopic investigation with biopsy from the terminal part of the oesophagus. Endoscopy picture was evaluated according Savary-Miller classification. Biopsy samples were histologically examined and evaluated according our proper classification of the reflux oesophagitis (1st degree: mild, 2nd degree: medium, 3rd degree: heavy, 4th degree: ulcerous). Endoscopical finding was normal in 59 patients (90.8%), reflux oesophagitis of the 1st degree in 2 patients (3.1%) 2nd degree in one patient (1.5%), 3rd degree in 2 patients (3.1%), 4th degree in one patient (1.5%). Histological changes which can be included into the picture of so called microscopic oesophagitis were found in 49 patients (75.4%). The rest of patients had the histology picture normal. CONCLUSION: In 75.4% of patients with chest pain and negative selective coronary angiogram histological examination revealed structural changes corresponding with oesophagitis, mostly of the mild type.
Chest Pain↗
Multicentre randomized trial comparing transport to primary angioplasty vs immediate thrombolysis vs combined strategy for patients with acute myocardial infarction presenting to a community hospital without a catheterization laboratory. The PRAGUE study.
BACKGROUND: Primary coronary angioplasty is an effective reperfusion strategy in acute myocardial infarction. However, its availability is limited, and transporting patients to an angioplasty centre in the acute phase of myocardial infarction has not yet been proved safe. METHODS: The PRAGUE study (PRimary Angioplasty in patients transferred from General community hospitals to specialized PTCA Units with or without Emergency thrombolysis) compared three reperfusion strategies in patients with acute myocardial infarction, presenting within 6 h of symptom onset at community hospitals without a catheterization laboratory: group A - thrombolytic therapy in community hospitals (n=99), group B - thrombolytic therapy during transportation to angioplasty (n=100), group C - immediate transportation for primary angioplasty without pre-treatment with thrombolysis (n=101). RESULTS: No complications occurred during transportation in group C. Two ventricular fibrillations occurred during transportation in group B. Median admission-reperfusion time in transported patients (group B 106 min, group C 96 min) compared favourably with the anticipated >90 min in group A. The combined primary end-point (death/reinfarction/stroke at 30 days) was less frequent in group C (8%) compared to groups B (15%) and A (23%, P<0. 02). The incidence of reinfarction was markedly reduced by transport to primary angioplasty (1% in group C vs 7% in group B vs 10% in group A, P<0.03). CONCLUSIONS: Transferring patients from community hospitals to a tertiary angioplasty centre in the acute phase of myocardial infarction is feasible and safe. This strategy is associated with a significant reduction in the incidence of reinfarction and the combined clinical end-point of death/reinfarction/stroke at 30 days when compared to standard thrombolytic therapy at the community hospital.
Aged↗
New insights in cardiac structural changes in patients with Fabry's disease.
BACKGROUND: Fabry's disease is an X-linked recessive genetic deficiency of the enzyme alpha-galactosidase leading to the pathologic intracellular deposition of neutral glycosphingolipids. Although cardiac involvement is frequent, there is controversy regarding the character of the associated left ventricular (LV) changes and the severity of valvular involvement. METHODS: Clinical evaluation (disease severity scaling, laboratory tests, and echocardiography) was performed in 13 hemizygous men (mean age 39 +/- 10 years) and 17 heterozygous women (mean age 35 +/- 19 years). RESULTS: LV hypertrophy (LVH) was frequent in subjects older than 30 years, more often in men (61%) than in women (18%, P <.001). The degree of LVH was independently associated with age and the logarithm of alpha-galactosidase activity (r(2) = 0.70, P <.001). The predominant LV geometric patterns were concentric LVH and remodeling, both present in 11 subjects (36%). Three patients had an asymmetric septal hypertrophy mimicking hypertrophic cardiomyopathy. In most subjects with LVH, the systolic function was normal and severe diastolic dysfunction (restrictive pattern) was not noted. Minor structural abnormalities of the mitral valve were found in 17 subjects (57%). The aortic valve was affected in 14 patients (47%). Valvular abnormalities were frequently accompanied by regurgitation of minor to mild degree. The presence of LVH or valvular changes was associated with increased disease severity. CONCLUSIONS: Echocardiographically detectable cardiac involvement is frequent with Fabry's disease, particularly in older subjects, and more pronounced in affected hemizygous men than in heterozygous women. LVH is frequently observed but usually not associated with significant systolic or restrictive diastolic dysfunction. Concentric LVH and remodeling appear to be the major manifestations of LV structural alteration. The frequently noted valvular abnormalities were not associated with a significant degree of regurgitation. Valvular and especially LV structural changes may serve as a useful marker of disease severity.
Adolescent↗
Direct stenting without predilatation: a new approach to coronary intervention.
BACKGROUND: Implantation of coronary stents after predilatation is a standard approach in the treatment of most coronary lesions. Stenting without predilatation could be a possible alternative way of treating a certain subset of patients. OBJECTIVE: To identify a group of patients suitable for this optional method, to evaluate their immediate clinical and angiographic outcomes and to test the feasibility and safety of this new therapeutic concept. METHODS: Ninety selected patients with 91 lesions were treated by implantation of coronary stents without predilatation. RESULTS: The mean duration of this procedure was 12.3 +/- 9.1 min and the fluoroscopic time was 3.6 +/- 2.9 min. The stenoses before and after this procedure were 77 +/- 10 and 5 +/- 9%, respectively. Predilatation, postdilatation or implantation of an additional stent was necessary for seven patients. Primary success rate was 92% with an excellent immediate clinical and angiographic outcome. No major complications occurred during direct stenting. CONCLUSION: Direct stenting is feasible using commercially available stents and could be performed for about 20% of patients for whom coronary intervention is indicated. The proper selection of lesions is of crucial importance. Lesions eligible for direct stenting should be without visible calcifications and on vessels without proximal tortuosity. This procedure proved to be safe and successful in this series of coronary interventions.
Angioplasty, Balloon, Coronary↗
[Intravascular ultrasonography in the year 2000].
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Cardiovascular Diseases↗
[Relation of the thickness of the intima and media of the common carotid artery, atherosclerotic plaque in the carotids and manifestations of atherosclerosis in the vessels of the lower extremity in comparison to coronary atherosclerosis].
BACKGROUND: Concomitant occurrence of carotid atherosclerosis, coronary artery disease (CAD) and peripheral vascular disease (PVD) has been described in a number of studies. The objective of the present trial was to assess the degree of correlation between atherosclerosis of the carotid beds as well as PVD and the extent of CAD. METHODS AND RESULTS: Carotid morphologies of 170 patients in total (121 men, 49 women), ranging between 23 and 81 years in age were assessed ultrasonographically. Their carotid beds searched for plaques, stenoses and occlusions. In all patients intima-media thickness (IMT) of the common carotid artery (CCA) were measured ultrasonographically. In addition, case histories of PVD were taken. CAD was proved angiographically in 138 patients. Plaques in carotid beds were found in 98 patients, carotid artery stenoses > 75% were found in 4 patients whereas complete carotid occlusion was not detected in any patient. Clinically manifested PVD was found in 20 patients. A significant difference in IMT of the CCA was assessed by t-test between patients having and not having CAD (0.67 +/- 0.16 mm vs. 0.87 +/- 0.24 mm; P < 0.0001). The correlation between the IMT of the CCA and extent of CAD was weak (r = 0.30, p < 0.01). A positive correlation between carotid plaque occurrence and the number of CAD-affected arteries was statistically assessed (Trend test: P = 0.0001). The sensitivity of incidence of plaques on the carotid beds for prediction of CAD was 64%, the specificity 72%, the positive predictive value 91% and the negative predictive value 32%. The sensitivity of clinically manifested PVD for prediction of CAD was 15%, the specificity 100%, the positive predictive value 100% and the negative predictive value 21%. CONCLUSIONS: The authors confirmed a statistically significant but weak correlation between IMT of the CCA and severity of CAD. They found a positive trend between the occurrence of carotid plaques and the number of CAD-affected arteries. The presence of carotid plaques and clinically manifested PVD were confirmed as a reliable positive predictive factors for CAD.
Adult↗
Prediction of indications for valve replacement among asymptomatic or minimally symptomatic patients with chronic aortic regurgitation and normal left ventricular performance.
BACKGROUND: Optimal criteria for valve replacement are unclear in asymptomatic/minimally symptomatic patients with aortic regurgitation (AR) and normal left ventricular (LV) performance at rest. Moreover, previous studies have not assessed the prognostic capacity of load-adjusted LV performance ("contractility") variables, which may be fundamentally related to clinical state. Therefore, 18 years ago, we set out to test prospectively the hypothesis that objective noninvasive measures of LV size and performance and, specifically, of load-adjusted variables, assessed at rest and during exercise (ex), could predict the development of currently accepted indications for operation for AR. METHODS AND RESULTS: Clinical variables and measures of LV size, performance, and end-systolic wall stress (ESS) were assessed annually in 104 patients by radionuclide cineangiography at rest and maximal ex and by echocardiography at rest; ESS was derived during ex. During an average 7.3-year follow-up among patients who had not been operated on, 39 of 104 patients either died suddenly (n = 4) or developed operable symptoms only (n = 22) or subnormal LV performance with or without symptoms (n = 13) (progression rate=6.2%/y). By multivariate Cox model analysis, change (delta) in LV ejection fraction (EF) from rest to ex, normalized for deltaESS from rest to ex (deltaLVEF-deltaESS index), was the strongest predictor of progression to any end point or to sudden cardiac death alone. Unadjusted deltaLVEF was almost as efficient. Symptom status modified prediction on the basis of the deltaLVEF-deltaESS index. The population tercile at highest risk by deltaLVEF-deltaESS progressed to end points at a rate of 13.3%/y, and the lowest-risk tercile progressed at 1.8%/y. CONCLUSIONS: Currently accepted symptom and LV performance indications for valve replacement, as well as sudden cardiac death, can be predicted in asymptomatic/minimally symptomatic patients with AR by load-adjusted deltaLVEF-deltaESS index, which includes data obtained during exercise.
Aortic Valve Insufficiency↗