TY - JOUR
T1 - mPAP/CO Slope and Oxygen Uptake Add Prognostic Value in Aortic Stenosis
AU - Hoedemakers, Sarah
AU - Pugliese, Nicola Riccardo
AU - Stassen, Jan
AU - Vanoppen, Arnaud
AU - Claessens, Jade
AU - Gojevic, Tin
AU - Bekhuis, Youri
AU - Falter, Maarten
AU - Moura Ferreira, Sara
AU - Dhont, Sebastiaan
AU - De Biase, Nicolò
AU - Del Punta, Lavinia
AU - Di Fiore, Valerio
AU - De Carlo, Marco
AU - Giannini, Cristina
AU - Colli, Andrea
AU - Dulgheru, Raluca Elena
AU - Geers, Jolien
AU - Yilmaz, Alaaddin
AU - Claessen, Guido
AU - Bertrand, Philippe
AU - Droogmans, Steven
AU - Lancellotti, Patrizio
AU - Cosyns, Bernard
AU - Verbrugge, Frederik H
AU - Herbots, Lieven
AU - Masi, Stefano
AU - Verwerft, Jan
N1 - Funding Information:
This research is partially funded by the Limburg Clinical Research Center of Hasselt University, Jessa and ZOL (Belgium; PhD grant), and the research cluster Centrum voor Hart-en Vaatziekten en Klinische Farmacie (CHVZ-KFAR), van de Vrije Universiteit Brussel. The research leading to these results has received funding from the European Union\u2013NextGenerationEU through the Italian Ministry of University and Research under PNRR-M4C2-I1.3 project PE_00000019 \u201CHEAL ITALIA\u201D to Stefano Taddei, CUP I53C22001440006. The views and opinions expressed are those of the authors only and do not necessarily reflect those of the European Union or the European Commission. Neither the European Union nor the European Commission can be held responsible for them.
Funding Information:
This research is partially funded by the Limburg Clinical Research Center of Hasselt University, Jessa and ZOL (Belgium; PhD grant), and the research cluster Centrum voor Hart-en Vaatziekten en Klinische Farmacie (CHVZKFAR), van de Vrije Universiteit Brussel. The research leading to these results has received funding from the European Union NextGenerationEU through the Italian Ministry of University and Research under PNRR-M4C2-I1.3 project PE_00000019 HEAL ITALIA to Stefano Taddei, CUP I53C22001440006. The views and opinions expressed are those of the authors only and do not necessarily reflect those of the European Union or the European Commission. Neither the European Union nor the European Commission can be held responsible for them.
Publisher Copyright:
© 2024 Lippincott Williams and Wilkins. All rights reserved.
PY - 2024/4/9
Y1 - 2024/4/9
N2 - BACKGROUND: Recent guidelines redefined exercise pulmonary hypertension as a mean pulmonary artery pressure/cardiac output (mPAP/CO) slope >3 mm Hg·L-1·min-1. A peak systolic pulmonary artery pressure >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.METHODS: In this prospective cohort study, consecutive patients (n=143; age, 73±11 years) with an aortic valve area ≤1.5 cm2 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).RESULTS: 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; P=0.036), indexed left atrial volume (OR per SD, 2.15; P=0.001), E/e' at rest (OR per SD, 1.61; P=0.012), mPAP/CO slope (OR per SD, 2.01; P=0.002), and age-, sex-, and height-based predicted peak exercise oxygen uptake (OR per SD, 0.59; P=0.007) were independently associated with cardiovascular events at 1 year, whereas peak systolic pulmonary artery pressure was not (OR per SD, 1.28; P=0.219). Peak Vo2 (percent) and mPAP/CO slope provided incremental prognostic value in addition to indexed left atrial volume and aortic valve area (P<0.001). These results were confirmed in the validation cohort.CONCLUSIONS: In moderate and severe aortic valve stenosis, mPAP/CO slope and percent-predicted peak Vo2 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 Vo2 and mPAP/CO slope cumulatively improved risk stratification.
AB - BACKGROUND: Recent guidelines redefined exercise pulmonary hypertension as a mean pulmonary artery pressure/cardiac output (mPAP/CO) slope >3 mm Hg·L-1·min-1. A peak systolic pulmonary artery pressure >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.METHODS: In this prospective cohort study, consecutive patients (n=143; age, 73±11 years) with an aortic valve area ≤1.5 cm2 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).RESULTS: 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; P=0.036), indexed left atrial volume (OR per SD, 2.15; P=0.001), E/e' at rest (OR per SD, 1.61; P=0.012), mPAP/CO slope (OR per SD, 2.01; P=0.002), and age-, sex-, and height-based predicted peak exercise oxygen uptake (OR per SD, 0.59; P=0.007) were independently associated with cardiovascular events at 1 year, whereas peak systolic pulmonary artery pressure was not (OR per SD, 1.28; P=0.219). Peak Vo2 (percent) and mPAP/CO slope provided incremental prognostic value in addition to indexed left atrial volume and aortic valve area (P<0.001). These results were confirmed in the validation cohort.CONCLUSIONS: In moderate and severe aortic valve stenosis, mPAP/CO slope and percent-predicted peak Vo2 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 Vo2 and mPAP/CO slope cumulatively improved risk stratification.
KW - Humans
KW - Middle Aged
KW - Aged
KW - Aged, 80 and over
KW - Prognosis
KW - Echocardiography, Stress/methods
KW - Atrial Fibrillation/diagnosis
KW - Prospective Studies
KW - Aortic Valve Stenosis/diagnosis
KW - Cardiac Output
KW - Heart Failure/complications
KW - Oxygen
UR - https://www.scopus.com/pages/publications/85190125587
U2 - 10.1161/CIRCULATIONAHA.123.067130
DO - 10.1161/CIRCULATIONAHA.123.067130
M3 - Article
C2 - 38410954
SN - 0009-7322
VL - 149
SP - 1172
EP - 1182
JO - Circulation
JF - Circulation
IS - 15
ER -