Article (Scientific journals)
Impact of global hemodynamic load on exercise capacity in aortic stenosis.
DULGHERU, Raluca Elena; Magne, Julien; Capoulade, R. et al.
2013In International Journal of Cardiology, 168 (3), p. 2272-7
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Keywords :
Aged; Aortic Valve Stenosis/diagnosis/physiopathology; Diastole; Echocardiography; Exercise Test; Exercise Tolerance; Female; Follow-Up Studies; Heart Ventricles/physiopathology/ultrasonography; Hemodynamics/physiology; Humans; Male; Middle Aged; Prognosis; Prospective Studies; Severity of Illness Index; Systole; Ventricular Function, Left; Aortic stenosis; Cardiopulmonary test; Functional capacity; Valve; Valvulo-arterial impedance
Abstract :
[en] BACKGROUND: The determinants of maximal exercise capacity (MEC) in aortic stenosis (AS) are, in large part, unknown. We hypothesized that the left ventricular (LV) global hemodynamic load--as assessed by the valvulo-arterial impedance (Zva)--is one of the main determinants of MEC and we sought to evaluate the factors associated with reduced MEC in AS. METHOD AND RESULTS: Asymptomatic patients with moderate or severe AS (n=62, aortic valve area <1.5 cm(2), 65 +/- 13 years, 68% men) and preserved LV systolic function (ejection fraction>50%) were prospectively referred for comprehensive resting echocardiography and cardiopulmonary exercise test. Absolute peak VO2 was 19.5 +/- 5.7 mL/kg/min (median 19.6 mL/kg/min; range 7.2-33.1 mL/kg/min). There were significant correlations between peak VO2 and: age, body mass index, LV stroke volumes, cardiac output, mean flow rate, mitral annulus s' and e' wave velocities, E/e' ratio and left atrial diameter (all p<0.05). Indexed mean flow rate and Zva were the strongest univariable echocardiographic determinants of peak VO2 (r=0.44, p<0.001 and r=-0.39, p=0.002, respectively). In addition, patients with reduced MEC (peak VO2<median) had higher Zva than those with preserved MEC (4.24 +/- 1.18 vs. 3.71 +/- 0.68 mmHg/mL/m(2), p=0.036). In multivariable analysis, age (p<0.001) and Zva (p=0.048) were the only independent predictors (r(2)=0.40) of peak VO2. CONCLUSION: In asymptomatic patients with moderate to severe AS, MEC varies widely among patients, and is often lower than expected. Global LV hemodynamic load is the main echocardiographic determinant of reduced MEC in these patients, suggesting its usefulness for their clinical evaluation and management.
Disciplines :
Cardiovascular & respiratory systems
Author, co-author :
DULGHERU, Raluca Elena ;  Centre Hospitalier Universitaire de Liège - CHU > Service de cardiologie
Magne, Julien ;  Université de Liège - ULiège > Département des sciences cliniques > Cardiologie - Pathologie spéciale et réhabilitation
Capoulade, R.
DAVIN, Laurent ;  Centre Hospitalier Universitaire de Liège - CHU > Service de cardiologie
Vinereanu, D.
Pierard, Luc ;  Université de Liège > Département des sciences cliniques > Cardiologie - Pathologie spéciale et réhabilitation
Pibarot, P.
LANCELLOTTI, Patrizio  ;  Centre Hospitalier Universitaire de Liège - CHU > Département de médecine interne > Service de cardiologie
Language :
English
Title :
Impact of global hemodynamic load on exercise capacity in aortic stenosis.
Publication date :
2013
Journal title :
International Journal of Cardiology
ISSN :
0167-5273
eISSN :
1874-1754
Publisher :
Elsevier, Netherlands
Volume :
168
Issue :
3
Pages :
2272-7
Peer reviewed :
Peer Reviewed verified by ORBi
Commentary :
Copyright (c) 2013 Elsevier Ireland Ltd. All rights reserved.
Available on ORBi :
since 12 June 2020

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