Exercise Hemodynamics After Aortic Valve Replacement for Severe Aortic Stenosis
| Autor: | Niels Marcussen, Eva Søndergaard, Jacob E. Møller, Akhmadjon Irmukhamedov, Jordi S. Dahl, Redi Pecini, Nicolaj Lyhne Christensen, Christian Hassager, Rasmus Carter-Storch |
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| Rok vydání: | 2018 |
| Předmět: |
Male
medicine.medical_specialty Heart Ventricles Exercise testing Population Diastole 030204 cardiovascular system & hematology Severity of Illness Index 030218 nuclear medicine & medical imaging 03 medical and health sciences 0302 clinical medicine Aortic valve replacement Myocardial fibrosis Internal medicine Humans Medicine Radiology Nuclear Medicine and imaging Postoperative Period Prospective Studies Pulmonary wedge pressure education Exercise Aged Heart Valve Prosthesis Implantation education.field_of_study business.industry Aortic stenosis Hemodynamics Aortic Valve Stenosis Stroke volume medicine.disease Stenosis medicine.anatomical_structure Echocardiography Ventricle Aortic Valve Heart Valve Prosthesis Cardiology Diastolic dysfunction Female Cardiology and Cardiovascular Medicine business Follow-Up Studies Artery |
| Zdroj: | Carter-Storch, R, Dahl, J S, Christensen, N L, Søndergaard, E V, Irmukhamedov, A, Pecini, R, Hassager, C, Marcussen, N & Møller, J E 2018, ' Exercise Hemodynamics After Aortic Valve Replacement for Severe Aortic Stenosis ', Journal of the American Society of Echocardiography, vol. 31, no. 10, pp. 1091-1100 . https://doi.org/10.1016/j.echo.2018.07.001 |
| ISSN: | 0894-7317 |
| Popis: | Background: Severe aortic stenosis (AS) is often accompanied by diastolic dysfunction. After aortic valve replacement (AVR), the left ventricle often undergoes considerable reverse remodeling. Despite this, diastolic dysfunction may persist after AVR. The aims of this study were to determine the incidence of elevated left ventricular (LV) filling pressure at rest and during exercise among patients with severe AS after AVR and to describe factors related to elevated LV filling pressure, especially its association with LV and left atrial remodeling and myocardial fibrosis. Methods: Thirty-seven patients undergoing AVR were included. Echocardiography, cardiac computed tomography, and magnetic resonance imaging were performed before AVR. An LV biopsy sample was obtained during AVR and analyzed for collagen fraction. One year after AVR, right heart catheterization with exercise was performed. A mean pulmonary capillary wedge pressure (PCWP) ≥ 28 mm Hg during exercise was considered elevated. Results: Twelve patients (32%) had elevated exercise PCWP 1 year after AVR. Exercise PCWP was highest among patients undergoing concomitant coronary artery bypass graft surgery (30 ± 7 vs 25 ± 6 mm Hg, P = .04) and among patients with preoperative stroke volume index < 35 mL/m2 (28 ± 8 vs 23 ± 4 mm Hg, P < .05). Baseline LV ejection fraction was lower among patients with elevated PCWP (56 ± 8% vs 64 ± 8%, P = .01), and coronary calcium score was significantly higher (median 870 AU [interquartile range, 454–2,491 AU] vs 179 AU [interquartile range, 63–513 AU], P = .02). Conversely, exercise PCWP was not related to the presence of high LV wall mass or to the severity of AS. Among patients undergoing isolated AVR, there was a correlation between LV interstitial volume fraction and PCWP (r = 0.57, P = .01) and mean pulmonary artery pressure (r = 0.51, P = .03) during exercise. Conclusions: Elevated filling pressure during exercise was seen in one third of patients after AVR in this population and was seen primarily among patients with coexisting ischemic heart disease or diffuse myocardial fibrosis but was unrelated to preoperative severity of AS and LV remodeling. |
| Databáze: | OpenAIRE |
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