Valvular & structural heart diseaseCohort study
Invasive Hemodynamic Exercise Response in Hemodynamically Significant Aortic Stenosis With Preserved Left Ventricular Ejection Fraction
- observational study
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