• Claessens, Jade
• Masi, Stefano
• Droogmans, Steven
• Stassen, Jan
• Biase, Nicolò De
• Dhont, Sebastiaan
• Colli, Andrea
• Falter, Maarten
• Gojevic, Tin
• Vanoppen, Arnaud
• Cosyns, Bernard
• Hoedemakers, Sarah
• Geers, Jolien
• Carlo, Marco De
• Verwerft, Jan
• Claessen, Guido
• Punta, Lavinia Del
• Yilmaz, Alaaddin
• Bertrand, Philippe B.
• Bekhuis, Youri
• Moura-Ferreira, Sara
• Herbots, Lieven
• Lancellotti, Patrizio
• Verbrugge, Frederik
• Giannini, Cristina
• Fiore, Valerio Di
• Pugliese, Nicola Riccardo
• Dulgheru, Raluca Elena

Abstract

<jats:sec><jats:title>BACKGROUND:</jats:title><jats:p>Recent guidelines redefined exercise pulmonary hypertension as a mean pulmonary artery pressure/cardiac output (mPAP/CO) slope &gt;3 mm Hg·L<jats:sup>−1</jats:sup>·min<jats:sup>−1</jats:sup>. A peak systolic pulmonary artery pressure &gt;60 mm Hg during exercise has been associated with an increased risk of cardiovascular death, heart failure rehospitalization, and aortic valve replacement in aortic valve stenosis. The prognostic value of the mPAP/CO slope in aortic valve stenosis remains unknown.</jats:p></jats:sec><jats:sec><jats:title>METHODS:</jats:title><jats:p>In this prospective cohort study, consecutive patients (n=143; age, 73±11 years) with an aortic valve area ≤1.5 cm<jats:sup>2</jats:sup>underwent cardiopulmonary exercise testing with echocardiography. They were subsequently evaluated for the occurrence of cardiovascular events (ie, cardiovascular death, heart failure hospitalization, new-onset atrial fibrillation, and aortic valve replacement) during a follow-up period of 1 year. Findings were externally validated (validation cohort, n=141).</jats:p></jats:sec><jats:sec><jats:title>RESULTS:</jats:title><jats:p>One cardiovascular death, 32 aortic valve replacements, 9 new-onset atrial fibrillation episodes, and 4 heart failure hospitalizations occurred in the derivation cohort, whereas 5 cardiovascular deaths, 32 aortic valve replacements, 1 new-onset atrial fibrillation episode, and 10 heart failure hospitalizations were observed in the validation cohort. Peak aortic velocity (odds ratio [OR] per SD, 1.48;<jats:italic>P</jats:italic>=0.036), indexed left atrial volume (OR per SD, 2.15;<jats:italic>P</jats:italic>=0.001), E/e’ at rest (OR per SD, 1.61;<jats:italic>P</jats:italic>=0.012), mPAP/CO slope (OR per SD, 2.01;<jats:italic>P</jats:italic>=0.002), and age-, sex-, and height-based predicted peak exercise oxygen uptake (OR per SD, 0.59;<jats:italic>P</jats:italic>=0.007) were independently associated with cardiovascular events at 1 year, whereas peak systolic pulmonary artery pressure was not (OR per SD, 1.28;<jats:italic>P</jats:italic>=0.219). Peak V<jats:sc>o</jats:sc><jats:sub>2</jats:sub>(percent) and mPAP/CO slope provided incremental prognostic value in addition to indexed left atrial volume and aortic valve area (<jats:italic>P</jats:italic>&lt;0.001). These results were confirmed in the validation cohort.</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS:</jats:title><jats:p>In moderate and severe aortic valve stenosis, mPAP/CO slope and percent-predicted peak V<jats:sc>o</jats:sc><jats:sub>2</jats:sub>were independent predictors of cardiovascular events, whereas peak systolic pulmonary artery pressure was not. In addition to aortic valve area and indexed left atrial volume, percent-predicted peak V<jats:sc>o</jats:sc><jats:sub>2</jats:sub>and mPAP/CO slope cumulatively improved risk stratification.</jats:p></jats:sec>

Topics

• Oxygen
• size-exclusion chromatography