The Functional Significance of Paradoxical Low-Gradient Aortic Valve Stenosis: Hemodynamic Findings During Cardiopulmonary Exercise Testing

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• 作者：Candelas Pé ; rez del Villar ; MD ; PhD ; Raquel Yotti ; MD ; PhD ; ^{raquel.yotti@salud.madrid.org} ; Marí ; a Á ; ngeles Espinosa ; MD ; PhD ; Enrique Gutié ; rrez-Ibañ ; es ; MD ; PhD ; Alicia Barrio ; DCS ; MBiol ; Marí ; a José ; Lorenzo ; BSN ; Pedro Luis Sá ; nchez Ferná ; ndez ; MD ; PhD ; Yolanda Benito ; DCS ; DVM ; Raquel Prieto ; MD ; PhD ; Esther Pé ; rez David ; MD ; PhD ; Pablo Martí ; nez-Legazpi ; MEng ; PhD ; Francisco Ferná ; ndez-Avilé ; s ; MD ; PhD ; Javier Bermejo ; MD ; PhD
• 关键词：aortic valve stenosis ; hemodynamics ; vascular function
• 刊名：JACC: Cardiovascular Imaging
• 出版年：2017
• 出版时间：January 2017
• 年：2017
• 卷：10
• 期：1
• 页码：29-39
• 全文大小：1097 K
• 卷排序：10

文摘

The goal of this study was to determine the functional impact of paradoxical low-gradient aortic stenosis (PLGAS) and clarify whether the relevance of the valvular obstruction is related to baseline flow.BackgroundEstablishing the significance of PLGAS is particularly challenging.MethodsTwenty symptomatic patients (77 ± 6 years of age; 17 female subjects) with PLGAS (mean gradient 28 ± 6 mm Hg; aortic valve area 0.8 ± 0.1 cm2; ejection fraction 66 ± 7%) underwent cardiopulmonary exercise testing combined with right-heart catheterization and Doppler echocardiographic measurements.ResultsAortic valve area increased by 84 ± 23% (p < 0.001) and, in 70% of subjects, it reached values >1.0 cm2 at peak exercise. Stroke volume index and blood pressure increased by 83 ± 56% and 26 ± 16%, respectively (both p < 0.0001). Peak oxygen consumption inversely correlated with the rate of increase in pulmonary capillary wedge pressure (PCWP) (PCWP slope: R = –0.61; p = 0.004). In turn, the PCWP slope was determined by changes in the valvular and vascular load but not by the rest of the indices of aortic stenosis. The functional impact of PLGAS was also not related to baseline flow. Agreement between Doppler echocardiography and the Fick technique was good up to intermediate workload.ConclusionsIn symptomatic patients with PLGAS, the capacity to dynamically reduce vascular and valvular loads determines the effect of exercise on PCWP, which, in turn, conditions the functional status. A critically fixed valvular obstruction may not be the main mechanism of functional impairment in a large proportion of patients with PLGAS. Exercise echocardiography is suitable to study the dynamics of PLGAS.