Interview with Dr Sabiha Gati about her review paper, ‘Exercise recommendations in patients with valvular disease’

Sabiha started as a CRY Research Fellow in 2010. She was the first CRY Fellow to complete a PhD, winning several awards and prizes for her research. After completing her PhD and specialist training,
Sabiha embarked on a 12 month fellowship training in cardiac MRI at Royal Brompton Hospital and subsequently worked as a Consultant Cardiologist in the unit. Sabiha currently works as a Consultant Cardiologist at Lister Hospital, Hertfordshire and continues her CMR work at the Brompton Hospital. Sabiha is also an associate editor for the EHJ-Case Reports.

Sabiha has had publications in a number of leading medical journals and is actively involved in CRY’s screening programme.

Why is valvular heart disease important in the young population?
Valvular heart disease affects approximately 3% of young individuals. Many of whom aspire to partake in competitive sport or high intensity recreational exercises. Research supported by CRY screening program has shown that 1 in 100 individuals have a minor cardiac structural abnormality such as bicuspid valve disease, mitral valve prolapse which requires surveillance throughout life. Therefore, early identification may prevent future heart complications.

Why does valve disease progress with exercise?
Reports on the natural history of valvular heart disease in exercising individuals is limited. However, there is a theoretical possibility that a large blood volume pumped out by the heart during exercise associated vigorous heart contractions may accelerate valve problems and may subsequently causes changes in the heart structure, function, electricity and even lead to sudden death.

How is valvular heart disease managed in exercising individuals?
The management of exercising individuals with valvular heart disease requires a structured approach which incorporates:

  1. Assessment of symptoms such as chest pain, breathlessness, dizziness and fluttering in the chest.
  2. Assessment of functional capacity.
  3. Type and nature of valve disease. Is it a left sided or right sided valve problem and is the valve narrowed or leaky.
  4. The impact on the heart structure and function.

Which valve abnormalities are common in young individuals?
Mitral valve prolapse and bicuspid aortic valves are the most common valvular abnormalities in the young exercising individuals. The good news is that the risk of adverse events is low but both valve abnormalities can be associated with important complications that require monitoring with an ultrasound scan of the heart.

Young people with minor valve abnormalities can compete in any sport. Those with moderate level of disease with require some further tests including an exercise treadmill test to assess how they do.

What advice would you give to exercising individuals with valve disease?
Exercising individuals with valve abnormalities should undergo yearly to 2 yearly assessment depending on the severity of valve disease they may have and we should inform them about the warning symptoms of progressive deterioration of valve disease.

For more information on CRY’s research please visit:

www.c-r-y.org.uk/research

  • Dr Sabiha Gati (CRY Research Fellow) with Jay Thomas (Sale Sharks Rugby Player) for press