Servicio de Cardiología, ICICOR, Hospital Clínico Universitario, Valladolid, Spain; CIBER de Enfermedades Cardiovasculares, Spain.
Servicio de Cardiología, ICICOR, Hospital Clínico Universitario, Valladolid, Spain; CIBER de Enfermedades Cardiovasculares, Spain.
Rev Esp Cardiol (Engl Ed). 2020 Jun;73(6):457-462. doi: 10.1016/j.rec.2019.03.005. Epub 2019 May 9.
Degenerative aortic stenosis (DAS) is the most frequent valvular heart disease. It remains unclear how to identify asymptomatic DAS patients with normal left ventricular ejection fraction who have a high probability of event occurrence and would thus benefit from early intervention. Here, we describe a protocol for exercise hemodynamics in true asymptomatic patients with moderate or severe DAS and assess the prognostic value of the data obtained in this population.
This study involved a prospective single-centre registry of consecutive asymptomatic patients with moderate or severe DAS. Patients underwent cardiopulmonary exercise testing to confirm symptom absence during exercise and then right heart catheterization (RHC) at rest and during exercise. Events were defined as death, surgical aortic valve replacement, or transcatheter aortic valve implantation according to clinical guidelines.
Thirty-three patients underwent baseline and exercise RHC. The mean aortic valve area was 1.08 cm and the aortic gradient was 39mmHg. The mean pulmonary artery pressure was 21mmHg with a pulmonary artery occlusion pressure of 14mmHg and cardiac output of 5.6 L/min. The mean pulmonary artery pressure at peak exercise was 34mmHg. After a mean follow-up of 27 months, 8 patients experienced an event (24%). There were no differences in baseline variables, aortic valve area, or cardiopulmonary exercise testing parameters between the event and event-free groups. Patients with an event did not have higher pulmonary or filling pressures after peak exercise but had lower pulmonary artery oxygen saturation on effort (median, 48% vs 57%, P=.03).
Exercise RHC is feasible and safe in this population. Peak pulmonary artery oxygen saturation might identify patients with increased risk of serious adverse events.
退行性主动脉瓣狭窄（DAS）是最常见的瓣膜性心脏病。目前尚不清楚如何识别左心室射血分数正常的无症状 DAS 患者，这些患者发生事件的概率较高，因此早期干预获益。在此，我们描述了一种针对真正无症状、中重度 DAS 患者的运动血液动力学的方案，并评估了该人群中获得的数据的预后价值。
这是一项连续无症状中重度 DAS 患者的前瞻性单中心登记研究。患者接受心肺运动测试以确认运动时无症状，然后在休息和运动时进行右心导管检查（RHC）。根据临床指南，事件定义为死亡、主动脉瓣置换手术或经导管主动脉瓣植入术。
33 例患者进行了基线和运动 RHC。平均主动脉瓣面积为 1.08cm，主动脉瓣梯度为 39mmHg。平均肺动脉压为 21mmHg，肺动脉闭塞压为 14mmHg，心输出量为 5.6L/min。运动峰值时的平均肺动脉压为 34mmHg。平均随访 27 个月后，8 例患者发生事件（24%）。事件组和无事件组的基线变量、主动脉瓣面积或心肺运动试验参数无差异。发生事件的患者在运动峰值后肺动脉或充盈压没有更高，但运动时肺动脉血氧饱和度更低（中位数分别为 48%和 57%，P=.03）。
该人群中运动 RHC 是可行且安全的。运动峰值时的肺动脉血氧饱和度可能识别出发生严重不良事件风险增加的患者。
