{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T19:23:16Z","timestamp":1791919396802,"version":"4.3.4"},"reference-count":35,"publisher":"BMJ","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Heart"],"accepted":{"date-parts":[[2000,7,17]]},"published-print":{"date-parts":[[2000,12,1]]},"abstract":"<jats:sec>\n                  <jats:title>OBJECTIVE<\/jats:title>\n                  <jats:p>To assess resting and exercise echocardiography for prediction of left ventricular dysfunction in patients with significant asymptomatic aortic regurgitation.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>DESIGN<\/jats:title>\n                  <jats:p>Cohort study of patients with aortic regurgitation.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>SETTING<\/jats:title>\n                  <jats:p>Tertiary referral centre specialising in valvar surgery.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>PATIENTS<\/jats:title>\n                  <jats:p>61 patients (38 men, 23 women; mean (SD) age 53 (14) years) with asymptomatic or minimally symptomatic aortic regurgitation and no known coronary artery disease; 35 were treated medically and 26 had aortic valve replacement.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>INTERVENTIONS<\/jats:title>\n                  <jats:p>Exercise echocardiography was used to evaluate ejection fraction, which was measured on the resting and post-stress images using the modified Simpson method. Patients with an increment of ejection fraction after exercise were denoted as having contractile reserve (CR+); those without an increment were labelled CR\u2212.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>MAIN OUTCOME MEASURES<\/jats:title>\n                  <jats:p>Standard univariate and multivariate methods and receiver operating characteristic analyses were used to assess the ability of contractile reserve to predict follow up ejection fraction.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS<\/jats:title>\n                  <jats:p>In the 35 medically treated patients, 13 of 21 (62%) with CR+ (mean (SD) ejection fraction increment 7 (3)%) had preserved ejection fraction on follow up. In the 14 patients with CR\u2212 (ejection fraction decrement 8 (4)%), 13 (93%) had a decrement of ejection fraction on follow up from 60 (5)% at baseline to 54 (3)% on follow up (p\u2009=\u20090.005). Age, resting left ventricular dimensions, medical treatment, aortic regurgitation severity, exercise capacity, and rate\u2013pressure product were similar in both CR+ and CR\u2212 groups. Among the 26 surgical patients, 13 showed CR+ (ejection fraction increase 9 (5)%), all of whom had an increase in ejection fraction on follow up (from 49% to 59%). Of 13 surgical patients with CR\u2212 (ejection fraction decrease 7 (5)%), 10 (77%) showed the same or worse ejection fraction on postoperative follow up.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS<\/jats:title>\n                  <jats:p>Contractile reserve on exercise echocardiography is a better predictor of left ventricular decompensation than resting indices in asymptomatic patients with aortic regurgitation. In patients undergoing aortic valve replacement, contractile reserve had a better correlation with resting ejection fraction on postoperative follow up. Measurement of contractile reserve may be useful to monitor the early development of myocardial dysfunction in asymptomatic patients with aortic regurgitation, and may help to optimise the timing of surgery.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/heart.84.6.606","type":"journal-article","created":{"date-parts":[[2002,7,27]],"date-time":"2002-07-27T06:37:59Z","timestamp":1027751879000},"page":"606-614","source":"Crossref","is-referenced-by-count":108,"title":["Exercise echocardiography predicts development of left ventricular dysfunction in medically and surgically treated patients with asymptomatic severe aortic regurgitation"],"prefix":"10.1136","volume":"84","author":[{"given":"S","family":"Wahi","sequence":"first","affiliation":[{"name":"aCleveland Clinic Foundation, Cleveland, Ohio, USA, \n\nbUniversity Department of Medicine, University of Queensland, Princess Alexandra Hospital, Ipswich Road, Brisbane, Qld 4102, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B","family":"Haluska","sequence":"additional","affiliation":[{"name":"aCleveland Clinic Foundation, Cleveland, Ohio, USA, \n\nbUniversity Department of Medicine, University of Queensland, Princess Alexandra Hospital, Ipswich Road, Brisbane, Qld 4102, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A","family":"Pasquet","sequence":"additional","affiliation":[{"name":"aCleveland Clinic Foundation, Cleveland, Ohio, USA, \n\nbUniversity Department of Medicine, University of Queensland, Princess Alexandra Hospital, Ipswich Road, Brisbane, Qld 4102, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C","family":"Case","sequence":"additional","affiliation":[{"name":"aCleveland Clinic Foundation, Cleveland, Ohio, USA, \n\nbUniversity Department of Medicine, University of Queensland, Princess Alexandra Hospital, Ipswich Road, Brisbane, Qld 4102, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C M","family":"Rimmerman","sequence":"additional","affiliation":[{"name":"aCleveland Clinic Foundation, Cleveland, Ohio, USA, \n\nbUniversity Department of Medicine, University of Queensland, Princess Alexandra Hospital, Ipswich Road, Brisbane, Qld 4102, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"T H","family":"Marwick","sequence":"additional","affiliation":[{"name":"aCleveland Clinic Foundation, Cleveland, Ohio, USA, \n\nbUniversity Department of Medicine, University of Queensland, Princess Alexandra Hospital, Ipswich Road, Brisbane, Qld 4102, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2000,12,1]]},"reference":[{"key":"2025100708215875000_84.6.606.1","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.44.3.368"},{"key":"2025100708215875000_84.6.606.2","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9343(73)90115-0"},{"key":"2025100708215875000_84.6.606.3","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9149(80)90468-3"},{"key":"2025100708215875000_84.6.606.4","doi-asserted-by":"crossref","first-page":"875","DOI":"10.1016\/S0022-5223(19)41186-0","article-title":"Long-term follow-up after isolated aortic valve replacement.","volume":"74","author":"Copeland","year":"1977","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2025100708215875000_84.6.606.5","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.61.3.471"},{"key":"2025100708215875000_84.6.606.6","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9149(77)80187-2"},{"key":"2025100708215875000_84.6.606.7","doi-asserted-by":"crossref","first-page":"484","DOI":"10.1161\/01.CIR.61.3.484","article-title":"Observations on the optimum time for operative intervention for aortic regurgitation. II. Serial echocardiographic evaluation of asymptomatic patients.","volume":"61","author":"Henry","year":"1980","journal-title":"Circulation"},{"key":"2025100708215875000_84.6.606.8","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9149(78)90927-X"},{"key":"2025100708215875000_84.6.606.9","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.62.6.1280"},{"key":"2025100708215875000_84.6.606.10","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.71.4.669"},{"key":"2025100708215875000_84.6.606.11","doi-asserted-by":"publisher","DOI":"10.1016\/0002-8703(81)90194-0"},{"key":"2025100708215875000_84.6.606.12","doi-asserted-by":"crossref","first-page":"587","DOI":"10.7326\/0003-4819-110-8-587","article-title":"Chronic aortic insufficiency: factors associated with progression to aortic valve replacement.","volume":"110","author":"Siemienczuk","year":"1989","journal-title":"Ann Intern Med"},{"key":"2025100708215875000_84.6.606.13","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1016\/S0022-5223(19)37970-X","article-title":"Valve replacement should not be performed in all asymptomatic patients with severe aortic incompetence.","volume":"79","author":"Rahimtoola","year":"1980","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2025100708215875000_84.6.606.14","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1161\/01.CIR.61.2.411","article-title":"Valve replacement in aortic insufficiency with left ventricular dysfunction.","volume":"61","author":"Clark","year":"1980","journal-title":"Circulation"},{"key":"2025100708215875000_84.6.606.15","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.67.1.216"},{"key":"2025100708215875000_84.6.606.16","doi-asserted-by":"crossref","first-page":"386","DOI":"10.1177\/000331978703800506","article-title":"Prognostic implications of left ventricular function during exercise in asymptomatic patients with aortic regurgitation.","volume":"38","author":"Lindsay","year":"1987","journal-title":"Angiology"},{"key":"2025100708215875000_84.6.606.17","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9149(79)90444-2"},{"key":"2025100708215875000_84.6.606.18","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.97.6.525"},{"key":"2025100708215875000_84.6.606.19","doi-asserted-by":"publisher","DOI":"10.1016\/S0735-1097(96)00281-1"},{"key":"2025100708215875000_84.6.606.20","first-page":"73","article-title":"Low dose dobutamine echocardiography in the assessment of contractile reserve to predict the outcome of valve replacement for chronic aortic regurgitation.","volume":"15","author":"Tam","year":"1999","journal-title":"Can J Cardiol"},{"key":"2025100708215875000_84.6.606.21","doi-asserted-by":"publisher","DOI":"10.1016\/S0735-1097(98)00454-9"},{"key":"2025100708215875000_84.6.606.22","doi-asserted-by":"publisher","DOI":"10.1016\/S0735-1097(87)80254-1"},{"key":"2025100708215875000_84.6.606.23","doi-asserted-by":"publisher","DOI":"10.1136\/hrt.61.4.336"},{"key":"2025100708215875000_84.6.606.24","doi-asserted-by":"publisher","DOI":"10.1016\/S0735-1097(86)80188-7"},{"key":"2025100708215875000_84.6.606.25","doi-asserted-by":"publisher","DOI":"10.1016\/S0735-1097(97)00150-2"},{"key":"2025100708215875000_84.6.606.26","doi-asserted-by":"publisher","DOI":"10.1016\/0002-8703(82)90336-2"},{"key":"2025100708215875000_84.6.606.27","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.68.3.509"},{"key":"2025100708215875000_84.6.606.28","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9149(83)90674-4"},{"key":"2025100708215875000_84.6.606.29","doi-asserted-by":"publisher","DOI":"10.1016\/S0735-1097(97)00329-X"},{"key":"2025100708215875000_84.6.606.30","doi-asserted-by":"publisher","DOI":"10.1253\/jcj.60.216"},{"key":"2025100708215875000_84.6.606.31","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.59.6.1188"},{"key":"2025100708215875000_84.6.606.32","doi-asserted-by":"publisher","DOI":"10.1136\/hrt.42.5.521"},{"key":"2025100708215875000_84.6.606.33","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9149(83)90316-8"},{"key":"2025100708215875000_84.6.606.34","doi-asserted-by":"crossref","first-page":"924","DOI":"10.1016\/S0735-1097(84)80350-2","article-title":"Relation between exercise-induced changes in ejection fraction and systolic loading conditions at rest in aortic regurgitation.","volume":"3","author":"Goldman","year":"1984","journal-title":"J Am Coll Cardiol"},{"key":"2025100708215875000_84.6.606.35","doi-asserted-by":"crossref","first-page":"561","DOI":"10.1161\/01.CIR.70.4.561","article-title":"Echocardiographic evaluation of the response to afterload stress test in young asymptomatic patients with chronic severe aortic regurgitation: sensitivity of the left ventricular end-systolic pressure\u2013volume relationship.","volume":"70","author":"Branzi","year":"1984","journal-title":"Circulation"}],"container-title":["Heart"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/heart.84.6.606","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,7]],"date-time":"2025-10-07T15:41:29Z","timestamp":1759851689000},"score":1,"resource":{"primary":{"URL":"https:\/\/heart.bmj.com\/lookup\/doi\/10.1136\/heart.84.6.606"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2000,12,1]]},"references-count":35,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2000,12,1]]},"published-print":{"date-parts":[[2000,12,1]]}},"alternative-id":["10.1136\/heart.84.6.606"],"URL":"https:\/\/doi.org\/10.1136\/heart.84.6.606","relation":{},"ISSN":["1355-6037","1468-201X"],"issn-type":[{"value":"1355-6037","type":"print"},{"value":"1468-201X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2000,12,1]]}}}