Complex Heart Valve Disease: Functional Capacity and Natriuretic Peptides Predict Outcomes in mixed and Multiple Heart Valve Disease

Abstract

Chronic mixed and multiple heart valve disease constitutes a complex group of cardiac pathologies that are prevalent world wide causing significant mortality and morbidity. The American Heart Association and the European Society of Cardiology concede in their guidelines that little data exists in the international literature on this important subject. Patients tend to adopt a sedentary lifestyle in order to cope with this illness and avoid symptoms causing a steady decline in functional capacity. A physically active lifestyle is imperative for a good quality of life and cardiovascular wellness. Significant functional impairment through disease portends an adverse prognosis. Functional capacity impairment can be objectively measured through formal cardiopulmonary exercise testing through determining the peak oxygen consumption (peakVO2). Exercise intolerance may suggest significant underlying symptoms especially in asymptomatic or mildly symptomatic states with severe heart valve lesions. The onset of symptoms is central to the decision to operate and surgical valve replacement. The peakVO2 measurement is the international gold standard of functional aerobic capacity and is widely used in heart failure and cardiac transplant to predict prognosis and outcome. The role of peakVO2 has not been evaluated in complex heart valve disease.