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Title: | mPAP/CO Slope and Oxygen Uptake Add Prognostic Value in Aortic Stenosis | Authors: | HOEDEMAKERS, Sarah Pugliese, Nicola Riccardo STASSEN, Jan Vanoppen, Arnaud CLAESSENS, Jade GOJEVIC, Tin BEKHUIS, Youri FALTER, Maarten MOURA FERREIRA, Sara DHONT, Sebastiaan De Biase, Nicolo Del Punta, Lavinia Di Fiore, Valerio De Carlo, Marco Giannini, Cristina Colli, Andrea Dulgheru, Raluca Elena Geers, Jolien Yilmaz, Alaaddin CLAESSEN, Guido BERTRAND, Philippe Droogmans, Steven Lancellotti, Patrizio Cosyns, Bernard VERBRUGGE, Frederik HERBOTS, Lieven Masi, Stefano VERWERFT, Jan |
Issue Date: | 2024 | Publisher: | LIPPINCOTT WILLIAMS & WILKINS | Source: | CIRCULATION, 149 (15) , p. 1172 -1182 | Abstract: | BACKGROUND: Recent guidelines redefined exercise pulmonary hypertension as a mean pulmonary artery pressure/cardiac output (mPAP/CO) slope >3 mm Hg<middle dot>L-1<middle dot>min(-1). A peak systolic pulmonary artery pressure >60 mm Hg during exercise has been associated with an increased risk of cardiovascular death, heart failure rehospitalization, and aortic valve replacement in aortic valve stenosis. The prognostic value of the mPAP/CO slope in aortic valve stenosis remains unknown. METHODS: In this prospective cohort study, consecutive patients (n=143; age, 73 +/- 11 years) with an aortic valve area <= 1.5 cm(2) underwent cardiopulmonary exercise testing with echocardiography. They were subsequently evaluated for the occurrence of cardiovascular events (ie, cardiovascular death, heart failure hospitalization, new-onset atrial fibrillation, and aortic valve replacement) during a follow-up period of 1 year. Findings were externally validated (validation cohort, n=141). RESULTS: One cardiovascular death, 32 aortic valve replacements, 9 new-onset atrial fibrillation episodes, and 4 heart failure hospitalizations occurred in the derivation cohort, whereas 5 cardiovascular deaths, 32 aortic valve replacements, 1 new-onset atrial fibrillation episode, and 10 heart failure hospitalizations were observed in the validation cohort. Peak aortic velocity (odds ratio [OR] per SD, 1.48; P=0.036), indexed left atrial volume (OR per SD, 2.15; P=0.001), E/e' at rest (OR per SD, 1.61; P=0.012), mPAP/CO slope (OR per SD, 2.01; P=0.002), and age-, sex-, and height-based predicted peak exercise oxygen uptake (OR per SD, 0.59; P=0.007) were independently associated with cardiovascular events at 1 year, whereas peak systolic pulmonary artery pressure was not (OR per SD, 1.28; P=0.219). Peak Vo(2) (percent) and mPAP/CO slope provided incremental prognostic value in addition to indexed left atrial volume and aortic valve area (P<0.001). These results were confirmed in the validation cohort. CONCLUSIONS: In moderate and severe aortic valve stenosis, mPAP/CO slope and percent-predicted peak Vo(2) were independent predictors of cardiovascular events, whereas peak systolic pulmonary artery pressure was not. In addition to aortic valve area and indexed left atrial volume, percent-predicted peak Vo(2) and mPAP/CO slope cumulatively improved risk stratification. | Notes: | Hoedemakers, S (corresponding author), Jessa Hosp, Dept Cardiol, Stadsomvaart 11, B-3500 Hasselt, Belgium. sarahhoed@gmail.com; jan.verwerft@jessazh.be; arnaud.vanoppen@gmail.com; jade.claessens@jessazh.be; tin.gojevic@uhasselt.be; youri.bekhuis@uzleuven.be; maarten.falter@jessazh.be; sebastiaan.dhont@zol.be; nicolo.debiase94@gmail.com; lavi19.16@gmail.com; difiore95@hotmail.it; marcodecarlo@gmail.com; cristinagianninimd@gmail.com; colli.andrea.bcn@gmail.com; eralucadulgheru@yahoo.com; jolien.geers@vub.be; alaaddin.yilmaz@jessazh.be; guido.claessen@jessazh.be; philippe.bertrand@zol.be; Steven.Droogmans@uzbrussel.be; plancellotti@chu.ulg.ac.be; Bernard.Cosyns@uzbrussel.be; lieven.herbots@jessazh.be; stefano.masi@unipi.it; jan.verwerft@jessazh.be |
Keywords: | aortic valve stenosis;cardiac output;exercise test;hypertension;pulmonary;prognosis | Document URI: | http://hdl.handle.net/1942/43274 | ISSN: | 0009-7322 | e-ISSN: | 1524-4539 | DOI: | 10.1161/CIRCULATIONAHA.123.067130 | ISI #: | 001233579200009 | Rights: | 2024 American Heart Association, Inc | Category: | A1 | Type: | Journal Contribution |
Appears in Collections: | Research publications |
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mPAP_CO Slope and Oxygen Uptake Add Prognostic Value in Aortic Stenosis.pdf Restricted Access | Published version | 611.5 kB | Adobe PDF | View/Open Request a copy |
Accepted_Manuscript (1).pdf | Peer-reviewed author version | 794.35 kB | Adobe PDF | View/Open |
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