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Title: | Cardiac dysfunction rather than aortic valve stenosis severity drives exercise intolerance and adverse haemodynamics | Authors: | 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 |
Issue Date: | 2023 | Publisher: | OXFORD UNIV PRESS | Source: | European Heart Journal-Cardiovascular Imaging, 25 (3), p. 302–312 | 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. Patients (n = 206) with at least moderate AS (aortic valve area <= 0.85 cm/m(2)) 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 (H2FPEF) 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).<br />Conclusion A high H2FPEF 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 | Notes: | Verbrugge, FH (corresponding author), Univ Hosp Brussels, Ctr Cardiovasc Dis, Laarbeeklaan 101, B-1090 Jette, Belgium.; Verbrugge, FH (corresponding author), Mayo Clin, Dept Cardiovasc Med, 1216 2nd St SW, Rochester, MN 55902 USA.; Verbrugge, FH (corresponding author), Vrije Univ Brussel VUB, Fac Med & Pharm, Laarbeeklaan 103, B-1090 Jette, Belgium. frederik.verbrugge@uzbrussel.be |
Keywords: | aortic valve stenosis;diastolic heart failure;exercise test;heart atria;haemodynamics | Document URI: | http://hdl.handle.net/1942/41944 | ISSN: | 2047-2404 | e-ISSN: | 2047-2412 | DOI: | 10.1093/ehjci/jead276 | ISI #: | 001102376500001 | Rights: | The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com. Open access | Category: | A1 | Type: | Journal Contribution |
Appears in Collections: | Research publications |
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