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Cardiac dysfunction rather than aortic valve stenosis severity drives exercise intolerance and adverse haemodynamics.
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- Author(s): Hoedemakers, Sarah; Verwerft, Jan; Reddy, Yogesh N V; Delvaux, Robin; Stroobants, Sarah; Jogani, Siddharth; Claessen, Guido; Droogmans, Steven; Cosyns, Bernard; Borlaug, Barry A; Herbots, Lieven; Verbrugge, Frederik H
- Source:
European Heart Journal - Cardiovascular Imaging; Mar2024, Vol. 25 Issue 3, p302-312, 11p- Subject Terms:
HYPERTENSION; EXERCISE tests; ECHOCARDIOGRAPHY; EXERCISE tolerance; VENTRICULAR ejection fraction; LEFT ventricular hypertrophy; PULMONARY hypertension; AORTIC stenosis; ATRIAL fibrillation; ARTERIAL pressure; SEVERITY of illness index; DIASTOLIC blood pressure; DESCRIPTIVE statistics; CARDIAC output; HEMODYNAMICS; HEART failure; LEFT heart atrium; AORTIC valve; DISEASE complications - Source:
- Additional Information
- Abstract: Aims To study the impact of heart failure with preserved ejection fraction (HFpEF) vs. aortic stenosis (AS) lesion severity on left ventricular (LV) hypertrophy, diastolic dysfunction, left atrial (LA) dysfunction, haemodynamics, and exercise capacity. Methods and results Patients (n = 206) with at least moderate AS (aortic valve area ≤0.85 cm/m2) and discordant symptoms underwent cardiopulmonary exercise testing with simultaneous echocardiography. The population was stratified according to the probability of underlying HFpEF by the heavy, hypertension, atrial fibrillation, pulmonary hypertension, elder, filling pressure (H
2 FPEF) score [0–5 (AS/HFpEF−) vs. 6–9 points (AS/HFpEF+)] and AS severity (Moderate vs. Severe). Mean age was 73 ± 10 years with 40% women. Twenty-eight patients had Severe AS/HFpEF+ (14%), 111 Severe AS/HFpEF− (54%), 13 Moderate AS/HFpEF+ (6%), and 54 Moderate AS/HFpEF− (26%). AS/HFpEF+ vs. AS/HFpEF− patients, irrespective of AS severity, had a lower LV global longitudinal strain, impaired diastolic function, reduced LV compliance, and more pronounced LA dysfunction. The pulmonary arterial pressure–cardiac output slope was significantly higher in AS/HFpEF+ vs. AS/HFpEF− (5.4 ± 3.1 vs. 3.9 ± 2.2 mmHg/L/min, respectively; P = 0.003), mainly driven by impaired cardiac output and chronotropic reserve, with signs of right ventricular pulmonary arterial uncoupling. AS/HFpEF+ vs. AS/HFpEF− was associated with a lower peak aerobic capacity (11.5 ± 3.7 vs. 15.9 ± 5.9 mL/min/kg, respectively; P < 0.0001) but did not differ between Moderate and Severe AS (14.7 ± 5.5 vs. 15.2 ± 5.9 mL/min/kg, respectively; P = 0.6). Conclusion A high H2 FPEF score is associated with a reduced exercise capacity and adverse haemodynamics in patients with moderate to severe AS. Both exercise performance and haemodynamics correspond better with intrinsic cardiac dysfunction than AS severity. [ABSTRACT FROM AUTHOR] - Abstract: Copyright of European Heart Journal - Cardiovascular Imaging is the property of Oxford University Press / USA and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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