Department of Cardiology Odense University Hospital, Odense, Denmark.
Department of Sports Science and Clinical Biomechanics University of Southern Denmark, Odense, Denmark.
PLoS One. 2019 Jul 30;14(7):e0215364. doi: 10.1371/journal.pone.0215364. eCollection 2019.
Aortic stenosis (AS) is a progressive disease in which left ventricular (LV) diastolic dysfunction is common. However, the association between diastolic dysfunction and right ventricular (RV) loading conditions and function has not been investigated in asymptomatic AS patients.
A total of 41 patients underwent right heart catheterization and simultaneous echocardiography at rest and during maximal supine exercise, stratified according to resting diastolic function. Cardiac chamber size and morphology was assessed using cardiac magnetic resonance imaging (cMRI). RV stroke work index, pulmonary artery (PA) compliance, PA elastance, PA pulsatility index, and right atrial pressure (RAP) were calculated at rest and maximal exercise. Ten patients (24%) had normal LV filling pattern, 20 patients (49%) had grade 1, and 11 patients (27%) had grade 2 diastolic dysfunction. Compared to patients with normal diastolic filling pattern, patients with diastolic dysfunction had lower RV end-diastolic volume (66 ± 11 ml/m2 vs. 79 ± 15 ml/m2, p = 0.02) and end-systolic volume (25 ± 7 ml/m2 vs. 32 ± 9 ml/m2, p = 0.04). An increase in mean RAP to ≥15 mmHg following exercise was not seen in patients with normal LV filling, compared to 4 patients (20%) with mild and 7 patients (63%) with moderate diastolic dysfunction (p = 0.003). PA pressure and PA elastance was increased in grade 2 diastolic dysfunction and correlated with RV volume and maximal oxygen consumption (r = -0.71, p < 0.001).
Moderate diastolic dysfunction is associated with increased RV afterload (elastance), which is compensated at rest, but is associated with increased RAP and inversely related to maximal oxygen consumption during maximal exercise.
主动脉瓣狭窄（AS）是一种进行性疾病，其中左心室（LV）舒张功能障碍很常见。然而，在无症状 AS 患者中，舒张功能障碍与右心室（RV）负荷状况和功能之间的关系尚未得到研究。
共有 41 例患者根据静息舒张功能进行分层，在休息和最大仰卧位运动时接受右心导管检查和同步超声心动图检查。使用心脏磁共振成像（cMRI）评估心腔大小和形态。在休息和最大运动时计算 RV 每搏功指数、肺动脉（PA）顺应性、PA 弹性、PA 搏动指数和右心房压（RAP）。10 例（24%）患者 LV 充盈模式正常，20 例（49%）患者为 1 级，11 例（27%）患者为 2 级舒张功能障碍。与 LV 充盈模式正常的患者相比，舒张功能障碍患者的 RV 舒张末期容积（66 ± 11 ml/m2 比 79 ± 15 ml/m2，p = 0.02）和收缩末期容积（25 ± 7 ml/m2 比 32 ± 9 ml/m2，p = 0.04）较低。在 LV 充盈正常的患者中，运动后平均 RAP 增加到≥15mmHg 并不常见，但在轻度舒张功能障碍的 4 例（20%）和中度舒张功能障碍的 7 例（63%）患者中可见（p = 0.003）。在 2 级舒张功能障碍中，PA 压力和 PA 弹性增加，并与 RV 容积和最大耗氧量相关（r = -0.71，p < 0.001）。
中度舒张功能障碍与 RV 后负荷（弹性）增加相关，后者在休息时得到代偿，但与 RAP 增加相关，并与最大运动时的最大耗氧量呈负相关。
