Heart failure & cardiomyopathies
Cardiac dysfunction rather than aortic valve stenosis severity drives exercise intolerance and adverse haemodynamics
Authors' 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.
Study context
- Population
- Patients with at least moderate aortic stenosis (AS) (aortic valve area ≤0.85 cm/m²) and discordant symptoms undergoing cardiopulmonary exercise testing with simultaneous echocardiography
- Participants
- 206 patients
- Exposure
- AS/heart failure with preserved ejection fraction (HFpEF)+ vs AS/HFpEF- and Severe vs Moderate AS
- Severe AS/HFpEF+n = 28
- Severe AS/HFpEF-n = 111
- Moderate AS/HFpEF+n = 13
- Moderate AS/HFpEF-n = 54
- Outcome
- Peak aerobic capacity and pulmonary arterial pressure-cardiac output slope
Main finding
As reported in the abstract
| Group | Value | Pulmonary arterial pressure-cardiac output slope |
|---|---|---|
| AS/HFpEF+ | mean 11.5 (SD 3.7) mL/min/kg | 5.4 ± 3.1 mmHg/L/min |
| AS/HFpEF- | mean 15.9 (SD 5.9) mL/min/kg | 3.9 ± 2.2 mmHg/L/min |
| Moderate AS | mean 14.7 (SD 5.5) mL/min/kg | |
| Severe AS | mean 15.2 (SD 5.9) mL/min/kg |
Value
AS/HFpEF+mean 11.5 (SD 3.7) mL/min/kg
AS/HFpEF-mean 15.9 (SD 5.9) mL/min/kg
Moderate ASmean 14.7 (SD 5.5) mL/min/kg
Severe ASmean 15.2 (SD 5.9) mL/min/kg
Pulmonary arterial pressure-cardiac output slope
AS/HFpEF+5.4 ± 3.1 mmHg/L/min
AS/HFpEF-3.9 ± 2.2 mmHg/L/min
Moderate AS— not stated in the abstract
Severe AS— not stated in the abstract
- AS/HFpEF+ vs AS/HFpEF-: P < 0.0001 — peak aerobic capacity
- Moderate AS vs Severe AS: P = 0.6 — peak aerobic capacity
- AS/HFpEF+ vs AS/HFpEF-: P = 0.003 — pulmonary arterial pressure-cardiac output slope
Observational data: associations, not effects.
Further findings
- Irrespective of AS severity, AS/HFpEF+ had lower left ventricular (LV) global longitudinal strain, impaired diastolic function, reduced LV compliance and more pronounced left atrial (LA) dysfunction
Original publication
Cardiac dysfunction rather than aortic valve stenosis severity drives exercise intolerance and adverse haemodynamics. Eur Heart J Cardiovasc Imaging. Published 24 October 2023. doi:10.
Composed by AI from the published abstract and checked against it. How Briefs are made →