Valvular & structural heart diseaseCohort study
Haemodynamic and Metabolic Phenotyping of Patients with Aortic Stenosis and Preserved Ejection Fraction: A Specific Phenotype of Heart Failure with Preserved Ejection Fraction?
- Prospective comparative cohort study
- age- and sex-matched healthy controls
- Cardiac computed tomography (CT) in ASpEF patients eligible for TAVR (n = 125)
Authors' conclusion
Functional capacity is similarly impaired in ASpEF and HFpEF due to both peripheral and central components.
Study context
- Population
- Patients with heart failure with preserved ejection fraction (HFpEF) or degenerative moderate-to-severe AS with preserved EF, and healthy controls351/364 (96%) performed exercise test
- Participants
- 148 / 150 / 66
- Exposure
- ASpEF vs HFpEF vs healthy controls
- HFpEFn = 148
- ASpEFn = 150
- Controlsn = 66reference
Main finding
As reported in the abstract
Exercise haemodynamics and metabolism (peak VO2, peak cardiac output, peak arteriovenous O2 difference)
HFpEF and ASpEF both had significantly lower peak VO2, peak cardiac output and peak arteriovenous O2 difference vs controls
all p < 0.01
ASpEF showed several extravalvular abnormalities at rest and during exercise, similar to HFpEF, vs controls
all p < 0.01
Observational data: associations, not effects.
Further findings
- AS phenotype in ASpEF
- 134/150, 89% · Severe high-gradient AS · Normal-flow, low-gradient 6/150 (4%) · Low-flow, low-gradient 10/150 (7%)
Epicardial adipose tissue (EAT) thickness
- EAT thickness significantly greater in ASpEF than HFpEF
- EAT inversely correlated with peak VO2 in all groups
- In ASpEF, EAT directly related to echocardiographic disease severity and CT aortic valve calcium burden
Demographics and biohumoral profiles
- Similar in HFpEF and ASpEF
Original publication
Haemodynamic and Metabolic Phenotyping of Patients with Aortic Stenosis and Preserved Ejection Fraction: A Specific Phenotype of Heart Failure with Preserved Ejection Fraction? Eur J Heart Fail. Published 14 September 2023. doi:10.1002/ejhf.3018
Summarised from the published abstract; every number is checked against it