Valvular & structural heart disease
Role of Cardiac Energetics in Aortic Stenosis Disease Progression: Identifying the High-risk Metabolic Phenotype
Authors' conclusion
A gradient of myocardial energetic deficit and steatosis exists across the spectrum of hypertrophied AS hearts, and these metabolic changes precede irreversible LV remodeling and subclinical dysfunction.
Study context
- Population
- Asymptomatic patients with aortic stenosis (AS) and healthy volunteers
- Participants
- 74 vs 13
- Exposure
- AS by left ventricular (LV) wall thickness quartiles vs healthy volunteers
- ASn = 74
- Healthy volunteersn = 13reference
- Outcome
- Myocardial phosphocreatine/ATP ratio across LV wall thickness quartiles
Main finding
As reported in the abstract
Q1
1.64
interval 1.53–1.94
Q2
1.50
interval 1.21–1.71
Q4
1.48
interval 1.18–1.70
- Progressive decline in phosphocreatine/ATP with increasing disease severity
- P = 0.02
Observational data: associations, not effects.
Further findings
| Outcome | Q1 | Q2 |
|---|---|---|
| Myocardial TG content across AV pressure gradient quartiles | 1.03 (interval 0.81–1.56) | 1.36 (interval 0.86–1.98) |
- Myocardial TG content across AV pressure gradient quartiles — Significant increase across AV pressure gradient quartiles
- P=0.034
Correlations of phosphocreatine/ATP
- Impaired systolic longitudinal strain related to energetic impairment
- r=0.219; P=0.03
- Independent predictor of LV wall thickness
- r=−0.20; P=0.04
- Associated with myocardial fibrosis
- r=−0.24; P=0.03
Metabolic and functional parameters by clinical AS severity
- Comparable results when graded by clinical severity of AS
Original publication
Role of Cardiac Energetics in Aortic Stenosis Disease Progression: Identifying the High-risk Metabolic Phenotype. Circ Cardiovasc Imaging. Published 17 October 2023. doi:10.
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