0561: Threshold of predictive SPAP dyspnea in mitral stenosis with Doppler cardiac stress at maximum effort

BackgroundA Doppler cardiac stress of mitral stenosis (MS), the threshold of the systolic pulmonary artery pressure (SPAP) at the peak of the effort proposed by the American Recommendations (AHA / ACC) for mitral dilation is 60mmHg. However, this value is questioned in the literatureObjectiveIn Doppler cardiac stress, determine the peak effort threshold of SPAP the prediction of the occurrence of dyspnea justifying percutaneous mitral dilation in patients with MSMethodologyProspective descriptive study conducted in the cardiology department of Beni Messous Hospital (Algiers) between March 2008 and December 2010. Havebeen included patients with mitral area≤2cm2, functional class I, II, III NYHA and SPAP≤60mm Hg at rest. Dyspnea was sought to stress test on a treadmill (30Watts/3min). Dyspnea was present in patients who stopped the exam to load≤90W. The stress echo Doppler was performed on table echocardiography (30W /3 min). The mean SPAP was measured at baseline and at the end of each level to the peak of the effort.ResultsThree hundred patients were included, aged 42.3±1.3 years, sex ratio of 0.23. At the end of the stress test, 182 patients had dyspnea (60.6%). A doppler ultrasound stress analysis of diagnostic qualities of SPAP with threshold recommendations Americans showed the following results at peak exercise: sensitivity=0.96, specificity=0.34, positive likelihood=1.45, positive predictive value (PPV)=69%, positive predictive error(PPE)=31%, informative expected capacity(IEC)=26.Our results show that maximum effort, the threshold of SPAP giving the best capabilities discrimination between patients and non dyspnea and patients with dyspnea was 75.5mmHg: sensitivity=0.80, specificity=0.98, positive likely hood=47.18, PPV=99%, PPE=1% and IEC=277ConclusionIn this study, the optimal value of the SPAP predictive peak effort dyspnea justifying the expansion is 75.5mmHg