Cardiac dysfunction rather than aortic valve stenosis severity drives exercise intolerance and adverse haemodynamics Article Swipe
Sarah Hoedemakers
,
Jan Verwerft
,
Yogesh N.V. Reddy
,
Robin Delvaux
,
Sarah Stroobants
,
Siddharth Jogani
,
Guido Claessen
,
Steven Droogmans
,
Bernard Cosyns
,
Barry A. Borlaug
,
Lieven Herbots
,
Frederik H. Verbrugge
·
YOU?
·
· 2023
· Open Access
·
· DOI: https://doi.org/10.1093/ehjci/jead276
YOU?
·
· 2023
· Open Access
·
· DOI: https://doi.org/10.1093/ehjci/jead276
Aims To study the impact of heart failure with preserved ejection fraction (HFpEF) vs. aortic stenosis (AS) lesion severity on left ventricular (LV) hypertrophy, diastolic dysfunction, left atrial (LA) dysfunction, haemodynamics, and exercise capacity. Methods and results Patients (n = 206) with at least moderate AS (aortic valve area ≤0.85 cm/m2) and discordant symptoms underwent cardiopulmonary exercise testing with simultaneous echocardiography. The population was stratified according to the probability of underlying HFpEF by the heavy, hypertension, atrial fibrillation, pulmonary hypertension, elder, filling pressure (H2FPEF) score [0–5 (AS/HFpEF−) vs. 6–9 points (AS/HFpEF+)] and AS severity (Moderate vs. Severe). Mean age was 73 ± 10 years with 40% women. Twenty-eight patients had Severe AS/HFpEF+ (14%), 111 Severe AS/HFpEF− (54%), 13 Moderate AS/HFpEF+ (6%), and 54 Moderate AS/HFpEF− (26%). AS/HFpEF+ vs. AS/HFpEF− patients, irrespective of AS severity, had a lower LV global longitudinal strain, impaired diastolic function, reduced LV compliance, and more pronounced LA dysfunction. The pulmonary arterial pressure–cardiac output slope was significantly higher in AS/HFpEF+ vs. AS/HFpEF− (5.4 ± 3.1 vs. 3.9 ± 2.2 mmHg/L/min, respectively; P = 0.003), mainly driven by impaired cardiac output and chronotropic reserve, with signs of right ventricular pulmonary arterial uncoupling. AS/HFpEF+ vs. AS/HFpEF− was associated with a lower peak aerobic capacity (11.5 ± 3.7 vs. 15.9 ± 5.9 mL/min/kg, respectively; P < 0.0001) but did not differ between Moderate and Severe AS (14.7 ± 5.5 vs. 15.2 ± 5.9 mL/min/kg, respectively; P = 0.6). Conclusion A high H2FPEF score is associated with a reduced exercise capacity and adverse haemodynamics in patients with moderate to severe AS. Both exercise performance and haemodynamics correspond better with intrinsic cardiac dysfunction than AS severity.
Related Topics
Concepts
Medicine
Cardiology
Internal medicine
Heart failure with preserved ejection fraction
Atrial fibrillation
Diastole
Exercise intolerance
Pulmonary hypertension
Heart failure
Population
Left ventricular hypertrophy
Stroke volume
Blood pressure
Ejection fraction
Environmental health
Metadata
- Type
- article
- Language
- en
- Landing Page
- https://doi.org/10.1093/ehjci/jead276
- OA Status
- green
- Cited By
- 9
- References
- 32
- Related Works
- 10
- OpenAlex ID
- https://openalex.org/W4387920343
All OpenAlex metadata
Raw OpenAlex JSON
- OpenAlex ID
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https://openalex.org/W4387920343Canonical identifier for this work in OpenAlex
- DOI
-
https://doi.org/10.1093/ehjci/jead276Digital Object Identifier
- Title
-
Cardiac dysfunction rather than aortic valve stenosis severity drives exercise intolerance and adverse haemodynamicsWork title
- Type
-
articleOpenAlex work type
- Language
-
enPrimary language
- Publication year
-
2023Year of publication
- Publication date
-
2023-10-23Full publication date if available
- Authors
-
Sarah Hoedemakers, Jan Verwerft, Yogesh N.V. Reddy, Robin Delvaux, Sarah Stroobants, Siddharth Jogani, Guido Claessen, Steven Droogmans, Bernard Cosyns, Barry A. Borlaug, Lieven Herbots, Frederik H. VerbruggeList of authors in order
- Landing page
-
https://doi.org/10.1093/ehjci/jead276Publisher landing page
- Open access
-
YesWhether a free full text is available
- OA status
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greenOpen access status per OpenAlex
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https://hdl.handle.net/1942/41944Direct OA link when available
- Concepts
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Medicine, Cardiology, Internal medicine, Heart failure with preserved ejection fraction, Atrial fibrillation, Diastole, Exercise intolerance, Pulmonary hypertension, Heart failure, Population, Left ventricular hypertrophy, Stroke volume, Blood pressure, Ejection fraction, Environmental healthTop concepts (fields/topics) attached by OpenAlex
- Cited by
-
9Total citation count in OpenAlex
- Citations by year (recent)
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2025: 5, 2024: 3, 2023: 1Per-year citation counts (last 5 years)
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32Number of works referenced by this work
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10Other works algorithmically related by OpenAlex
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| referenced_works | https://openalex.org/W122121821, https://openalex.org/W2736888189, https://openalex.org/W2588638837, https://openalex.org/W6787121071, https://openalex.org/W3193942184, https://openalex.org/W4205537664, https://openalex.org/W2990599276, https://openalex.org/W3160150160, https://openalex.org/W4280518418, https://openalex.org/W2804511116, https://openalex.org/W3034837480, https://openalex.org/W3130881872, https://openalex.org/W3099224142, https://openalex.org/W4206647605, https://openalex.org/W2605115422, https://openalex.org/W2003379318, https://openalex.org/W2313186535, https://openalex.org/W2925344814, https://openalex.org/W2107836188, https://openalex.org/W3206075973, https://openalex.org/W1999291203, https://openalex.org/W2163296746, https://openalex.org/W2079265896, https://openalex.org/W6831322419, https://openalex.org/W2112050863, https://openalex.org/W2322310887, https://openalex.org/W2986138421, https://openalex.org/W3212990746, https://openalex.org/W4200194016, https://openalex.org/W2988788233, https://openalex.org/W2789621638, https://openalex.org/W3112785303 |
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