Diastolic Dysfunction Is Unmasked on Exercise in Patients With Asymptomatic, Severe Aortic Stenosis: An Invasive Hemodynamic Study

被引:6
|
作者
Kvaslerud, Anette B. [1 ,2 ,3 ]
Gude, Einar [1 ]
Eriksen, Gunnar [1 ]
Andreassen, Arne K. [1 ]
Gullestad, Lars [1 ,2 ,3 ]
Broch, Kaspar [1 ,2 ,3 ]
机构
[1] Oslo Univ Hosp, Rikshosp, Dept Cardiol, Oslo, Norway
[2] Univ Oslo, KG Jebsen Ctr Cardiac Res, Ctr Heart Failure Res, Oslo, Norway
[3] Univ Oslo, Fac Med, Oslo, Norway
关键词
aortic valve; catheterization; exercise; hemodynamics; pulmonary hypertension; PULMONARY-HYPERTENSION; VALVE; DIAGNOSIS; RESPONSES; CRITERIA; PROFILE;
D O I
10.1161/CIRCHEARTFAILURE.121.009253
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: Optimal timing of aortic valve replacement remains difficult in patients with asymptomatic, severe aortic stenosis (AS). More accurate diagnostic methods are warranted for the detection of subtle ventricular impairment. We aimed to evaluate diastolic function in asymptomatic patients with severe AS. Methods: In this cross-sectional study, patients with asymptomatic, severe AS were evaluated with right heart catheterization at rest and during moderate exercise. The patients also underwent cardiopulmonary exercise testing to objectify functional capacity and confirm the absence of symptoms. Results: Between February 2019 and May 2021, we included 50 patients aged 70 +/- 12 years. The patients had severe AS with peak velocity 4.4 +/- 0.4 m/s, mean gradient 46 +/- 9 mm Hg, and an indexed valve area of 0.47 +/- 0.08 cm(2) at rest. All patients were asymptomatic and had normal left ventricular ejection fraction. Five patients had postcapillary pulmonary hypertension at rest. During exercise, 44 patients (88%) had an increase in the mean pulmonary artery pressure per increase in cardiac output of >3 mm Hg/L per minute, of whom 93% had a concomitant increase in the pulmonary artery wedge pressure per increase in cardiac output >2 mm Hg/L per minute, suggesting exercise-induced pulmonary hypertension due to left heart disease. Female gender and increasing age were associated with a higher increase in the pulmonary artery wedge pressure per increase in cardiac output ratio. The catheterization was well tolerated, and there were no adverse events. Conclusions: A large proportion of asymptomatic patients with severe, degenerative AS have exercise-induced postcapillary pulmonary hypertension.
引用
收藏
页数:9
相关论文
共 50 条
  • [31] What is the real practice of exercise echocardiographic testing in asymptomatic patients with severe aortic stenosis?
    Cho, Eun Jeong
    Park, Sung-Ji
    Song, Jung-Eun
    Kim, Seol-Hwa
    Lee, Yung-Joo
    Gak, Ji-Hye
    Chang, Sung-A
    Lee, Sang-Chol
    Park, Seung Woo
    CHINESE MEDICAL JOURNAL, 2013, 126 (24) : 4649 - 4654
  • [32] Argument for a Doppler echocardiography during exercise in assessing asymptomatic patients with severe aortic stenosis
    Leurent, Guillaume
    Donal, Erwan
    de Place, Christian
    Chabanne, Celine
    Gervais, Renaud
    Fougerou, Claire
    le Helloco, Alain
    Daubert, Jean-Claude
    Mabo, Philippe
    Laurent, Marcel
    EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY, 2009, 10 (01): : 69 - 73
  • [33] Relation of microvascular dysfunction to exercise capacity and symptoms in patients with severe aortic stenosis
    Steadman C.D.
    Jerosch-Herold M.
    Grundy B.
    Rafelt S.
    Ng L.L.
    Squire I.B.
    Samani N.J.
    McCann G.P.
    Journal of Cardiovascular Magnetic Resonance, 13 (Suppl 1)
  • [34] Management of Patients With Asymptomatic Severe Aortic Stenosis and Severe Anemia
    Natale, Francesco
    Baldini, Luca
    Di Marco, Giovanni Maria
    Aronne, Luigi
    Calabro, Paolo
    Russo, Maria Giovanna
    Calabro, Raffaele
    AMERICAN JOURNAL OF CARDIOLOGY, 2010, 105 (03): : 423 - 423
  • [35] Early aortic valve replacement improves exercise capacity in truly asymptomatic patients with severe aortic stenosis
    Banovic, M.
    Boskovic, N.
    Bojanic, M.
    Nedeljkovic, I.
    Jovanovic, M.
    Penicka, M.
    Bartunek, J.
    EUROPEAN HEART JOURNAL, 2022, 43 : 1629 - 1629
  • [36] Exercise Tolerance in Rats with Aortic Stenosis and Ventricular Diastolic and/or Systolic Dysfunction
    Mendes, Olga Castro
    Sugizaki, Mario Mateus
    Campos, Dijon Salome
    Damatto, Ricardo Luiz
    Leopoldo, Andre Soares
    Lima-Leopoldo, Ana Paula
    Baldissera, Vilmar
    Padovani, Carlos Roberto
    Okoshi, Katashi
    Cicogna, Antonio Carlos
    ARQUIVOS BRASILEIROS DE CARDIOLOGIA, 2013, 100 (01) : 44 - 51
  • [37] Outcome of elderly patients with severe but asymptomatic aortic stenosis
    Zilberszac, R.
    Gabriel, H.
    Maurer, G.
    Rosenhek, R.
    EUROPEAN HEART JOURNAL, 2012, 33 : 527 - 527
  • [38] Role of BNP in patients with severe asymptomatic aortic stenosis
    Patel, DN
    Bailey, SR
    EUROPEAN HEART JOURNAL, 2004, 25 (22) : 1972 - 1973
  • [39] Current management of asymptomatic patients with severe aortic stenosis
    Iung, B
    Baron, G
    Delahaye, F
    Tornos, P
    Vermeer, F
    Levang, OW
    Vanoverschelde, JL
    Gohlke-Bärwolf, C
    Deckers, JW
    Vahanian, A
    CIRCULATION, 2003, 108 (17) : 514 - 514
  • [40] Impact of Left Ventricular Diastolic Dysfunction and Biomarkers on Pulmonary Hypertension in Patients with Severe Aortic Stenosis
    Gumauskiene, Birute
    Krivickiene, Ausra
    Jonkaitiene, Regina
    Vaskelyte, Jolanta Justina
    Siudikas, Adakrius
    Ereminiene, Egle
    MEDICINA-LITHUANIA, 2018, 54 (04):