Valvular & structural heart disease
Invasive Hemodynamic Exercise Response in Hemodynamically Significant Aortic Stenosis With Preserved Left Ventricular Ejection Fraction
Authors' conclusion
Discordant LG and HG severe AS had similar hemodynamic responses to exercise with steeper PCWP/CO-slope than in moderate AS, suggesting that discordant LG AS is a severe form of AS. In addition, the left upwards shift in PCWP/CO-curve for discordant LG compared with HG severe AS indicates that this group also has heart failure with preserved ejection fraction physiology.
Study context
- Population
- Patients with asymptomatic discordant aortic stenosis (AS) and left ventricular ejection fraction ≥50%; aortic valve area ≤1.5 cm 2, undergoing right heart catheterization at rest and during maximal exercisediscordant low-gradient (LG) AS 17 (20%) · moderate AS 49 (57%) · high-gradient (HG) severe AS 20 (23%)
- Participants
- 86 patients
- Exposure
- Exercise hemodynamics in discordant LG AS and HG severe AS compared with moderate AS
- discordant LG ASn = 17
- moderate ASn = 49
- HG severe ASn = 20
Main finding
As reported in the abstract
Discordant LG AS
3.3
median · IQR 2.1–4.3 · mm Hg/L/min
HG severe AS
2.7
median · IQR 1.9–3.4 · mm Hg/L per minute
Moderate AS
1.9
median · IQR 0.7–2.8 · mm Hg/L per minute
- Significantly steeper in discordant LG and HG severe AS compared with moderate AS
- P = 0.004
Observational data: associations, not effects.
Further findings
Factors associated with the pulmonary capillary wedge pressure (PCWP)/cardiac output (CO)-slope
- Systemic arterial compliance and AS severity were significantly associated with the PCWP/CO-slope
- Regression model adjusted for age, sex, and rest PCWP
PCWP/CO-curve
- Patients with discordant LG AS had a leftward-upward shift in the PCWP/CO-curve
Original publication
Summarised from the published abstract; every number is checked against it