[en] 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 cm(2) 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 Vo(2) (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 Vo(2) 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 Vo(2) and mPAP/CO slope cumulatively improved risk stratification.
Disciplines :
Cardiovascular & respiratory systems
Author, co-author :
Hoedemakers, Sarah ; Departments of Cardiology, Jessa Hospital, Hasselt, Belgium. (S.H., J.S., M.F., S.M.F., G.C., L.H., J.V.). ; Faculty of Medicine and Life Sciences, UHasselt, Agoralaan, Diepenbeek, Belgium (S.H., J.S., J.C., T.G., Y.B., M.F., S.M.F., S.D., G.C., P.B., L.H., J.V.). ; Limburg Clinical Research Center (-MHU), Hasselt, Belgium (S.H., J.S., J.C., T.G., Y.B., M.F., S.M.F., S.D., G.C., P.B., L.H., J.V.). ; Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium (S.H., J.G., S.D., B.C., F.H.V.).
Pugliese, Nicola Riccardo ; Department of Clinical and Experimental Medicine, University of Pisa, Italy (N.R.P., N.D.B., L.D.P., V.D.F., S.M.).
Stassen, Jan ; Departments of Cardiology, Jessa Hospital, Hasselt, Belgium. (S.H., J.S., M.F., S.M.F., G.C., L.H., J.V.). ; Faculty of Medicine and Life Sciences, UHasselt, Agoralaan, Diepenbeek, Belgium (S.H., J.S., J.C., T.G., Y.B., M.F., S.M.F., S.D., G.C., P.B., L.H., J.V.). ; Limburg Clinical Research Center (-MHU), Hasselt, Belgium (S.H., J.S., J.C., T.G., Y.B., M.F., S.M.F., S.D., G.C., P.B., L.H., J.V.).
Vanoppen, Arnaud; Faculty of Medicine, KU Leuven, Belgium (A.V., Y.B., M.F.).
Claessens, Jade ; Department of Cardiothoracic Surgery, Jessa Hospital, Hasselt, Belgium. (J.C., A.Y.). ; Faculty of Medicine and Life Sciences, UHasselt, Agoralaan, Diepenbeek, Belgium (S.H., J.S., J.C., T.G., Y.B., M.F., S.M.F., S.D., G.C., P.B., L.H., J.V.). ; Limburg Clinical Research Center (-MHU), Hasselt, Belgium (S.H., J.S., J.C., T.G., Y.B., M.F., S.M.F., S.D., G.C., P.B., L.H., J.V.).
Gojevic, Tin; Faculty of Medicine and Life Sciences, UHasselt, Agoralaan, Diepenbeek, Belgium (S.H., J.S., J.C., T.G., Y.B., M.F., S.M.F., S.D., G.C., P.B., L.H., J.V.). ; Limburg Clinical Research Center (-MHU), Hasselt, Belgium (S.H., J.S., J.C., T.G., Y.B., M.F., S.M.F., S.D., G.C., P.B., L.H., J.V.).
Bekhuis, Youri ; Faculty of Medicine and Life Sciences, UHasselt, Agoralaan, Diepenbeek, Belgium (S.H., J.S., J.C., T.G., Y.B., M.F., S.M.F., S.D., G.C., P.B., L.H., J.V.). ; Limburg Clinical Research Center (-MHU), Hasselt, Belgium (S.H., J.S., J.C., T.G., Y.B., M.F., S.M.F., S.D., G.C., P.B., L.H., J.V.). ; Faculty of Medicine, KU Leuven, Belgium (A.V., Y.B., M.F.).
Falter, Maarten; Departments of Cardiology, Jessa Hospital, Hasselt, Belgium. (S.H., J.S., M.F., S.M.F., G.C., L.H., J.V.). ; Faculty of Medicine and Life Sciences, UHasselt, Agoralaan, Diepenbeek, Belgium (S.H., J.S., J.C., T.G., Y.B., M.F., S.M.F., S.D., G.C., P.B., L.H., J.V.). ; Limburg Clinical Research Center (-MHU), Hasselt, Belgium (S.H., J.S., J.C., T.G., Y.B., M.F., S.M.F., S.D., G.C., P.B., L.H., J.V.). ; Faculty of Medicine, KU Leuven, Belgium (A.V., Y.B., M.F.).
Moura Ferreira, Sara ; Departments of Cardiology, Jessa Hospital, Hasselt, Belgium. (S.H., J.S., M.F., S.M.F., G.C., L.H., J.V.). ; Faculty of Medicine and Life Sciences, UHasselt, Agoralaan, Diepenbeek, Belgium (S.H., J.S., J.C., T.G., Y.B., M.F., S.M.F., S.D., G.C., P.B., L.H., J.V.). ; Limburg Clinical Research Center (-MHU), Hasselt, Belgium (S.H., J.S., J.C., T.G., Y.B., M.F., S.M.F., S.D., G.C., P.B., L.H., J.V.).
Dhont, Sebastiaan; Faculty of Medicine and Life Sciences, UHasselt, Agoralaan, Diepenbeek, Belgium (S.H., J.S., J.C., T.G., Y.B., M.F., S.M.F., S.D., G.C., P.B., L.H., J.V.). ; Limburg Clinical Research Center (-MHU), Hasselt, Belgium (S.H., J.S., J.C., T.G., Y.B., M.F., S.M.F., S.D., G.C., P.B., L.H., J.V.). ; Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium (S.D., P.B.).
De Biase, Nicolò ; Department of Clinical and Experimental Medicine, University of Pisa, Italy (N.R.P., N.D.B., L.D.P., V.D.F., S.M.).
Del Punta, Lavinia; Department of Clinical and Experimental Medicine, University of Pisa, Italy (N.R.P., N.D.B., L.D.P., V.D.F., S.M.).
Di Fiore, Valerio; Department of Clinical and Experimental Medicine, University of Pisa, Italy (N.R.P., N.D.B., L.D.P., V.D.F., S.M.).
De Carlo, Marco ; Cardiac, Thoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy (M.D.C., C.G., A.C.).
Giannini, Cristina; Departments of Cardiology, Jessa Hospital, Hasselt, Belgium. (S.H., J.S., M.F., S.M.F., G.C., L.H., J.V.). ; Faculty of Medicine and Life Sciences, UHasselt, Agoralaan, Diepenbeek, Belgium (S.H., J.S., J.C., T.G., Y.B., M.F., S.M.F., S.D., G.C., P.B., L.H., J.V.). ; Limburg Clinical Research Center (-MHU), Hasselt, Belgium (S.H., J.S., J.C., T.G., Y.B., M.F., S.M.F., S.D., G.C., P.B., L.H., J.V.).
Droogmans, Steven ; Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium (S.H., J.G., S.D., B.C., F.H.V.). ; Centrum voor Hart-en Vaatziekten, Universitair Ziekenhuis Brussel, Jette, Belgium (S.D., B.C., F.H.V.).
Lancellotti, Patrizio ; Université de Liège - ULiège > Département des sciences cliniques > Cardiologie - Pathologie spéciale et réhabilitation ; Gruppo Villa Maria Care and Research, Maria Cecilia Hospital, Cotignola, and Anthea Hospital, Bari, Italy (P.L.).
Cosyns, Bernard; Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium (S.H., J.G., S.D., B.C., F.H.V.). ; Centrum voor Hart-en Vaatziekten, Universitair Ziekenhuis Brussel, Jette, Belgium (S.D., B.C., F.H.V.).
Verbrugge, Frederik H ; Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium (S.H., J.G., S.D., B.C., F.H.V.). ; Centrum voor Hart-en Vaatziekten, Universitair Ziekenhuis Brussel, Jette, Belgium (S.D., B.C., F.H.V.).
Herbots, Lieven ; Departments of Cardiology, Jessa Hospital, Hasselt, Belgium. (S.H., J.S., M.F., S.M.F., G.C., L.H., J.V.). ; Faculty of Medicine and Life Sciences, UHasselt, Agoralaan, Diepenbeek, Belgium (S.H., J.S., J.C., T.G., Y.B., M.F., S.M.F., S.D., G.C., P.B., L.H., J.V.). ; Limburg Clinical Research Center (-MHU), Hasselt, Belgium (S.H., J.S., J.C., T.G., Y.B., M.F., S.M.F., S.D., G.C., P.B., L.H., J.V.).
Masi, Stefano ; Department of Clinical and Experimental Medicine, University of Pisa, Italy (N.R.P., N.D.B., L.D.P., V.D.F., S.M.).
Verwerft, Jan ; Departments of Cardiology, Jessa Hospital, Hasselt, Belgium. (S.H., J.S., M.F., S.M.F., G.C., L.H., J.V.). ; Faculty of Medicine and Life Sciences, UHasselt, Agoralaan, Diepenbeek, Belgium (S.H., J.S., J.C., T.G., Y.B., M.F., S.M.F., S.D., G.C., P.B., L.H., J.V.). ; Limburg Clinical Research Center (-MHU), Hasselt, Belgium (S.H., J.S., J.C., T.G., Y.B., M.F., S.M.F., S.D., G.C., P.B., L.H., J.V.).
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