Department of Cardiology, Rikshospitalet, Oslo University Hospital, Norway (A.B.K., E.G., G.E., A.K.A., L.G., K.B.).
KG Jebsen Center for Cardiac Research, Center for Heart Failure Research (A.B.K., L.G., K.B.), University of Oslo, Norway.
Circ Heart Fail. 2022 Feb;15(2):e009253. doi: 10.1161/CIRCHEARTFAILURE.121.009253. Epub 2022 Feb 9.
Optimal timing of aortic valve replacement remains difficult in patients with asymptomatic, severe aortic stenosis (AS). More accurate diagnostic methods are warranted for the detection of subtle ventricular impairment. We aimed to evaluate diastolic function in asymptomatic patients with severe AS.
In this cross-sectional study, patients with asymptomatic, severe AS were evaluated with right heart catheterization at rest and during moderate exercise. The patients also underwent cardiopulmonary exercise testing to objectify functional capacity and confirm the absence of symptoms.
Between February 2019 and May 2021, we included 50 patients aged 70±12 years. The patients had severe AS with peak velocity 4.4±0.4 m/s, mean gradient 46±9 mm Hg, and an indexed valve area of 0.47±0.08 cm at rest. All patients were asymptomatic and had normal left ventricular ejection fraction. Five patients had postcapillary pulmonary hypertension at rest. During exercise, 44 patients (88%) had an increase in the mean pulmonary artery pressure per increase in cardiac output of >3 mm Hg/L per minute, of whom 93% had a concomitant increase in the pulmonary artery wedge pressure per increase in cardiac output >2 mm Hg/L per minute, suggesting exercise-induced pulmonary hypertension due to left heart disease. Female gender and increasing age were associated with a higher increase in the pulmonary artery wedge pressure per increase in cardiac output ratio. The catheterization was well tolerated, and there were no adverse events.
A large proportion of asymptomatic patients with severe, degenerative AS have exercise-induced postcapillary pulmonary hypertension.
对于无症状、重度主动脉瓣狭窄（AS）患者，主动脉瓣置换的最佳时机仍然难以确定。需要更准确的诊断方法来检测细微的心室功能障碍。我们旨在评估无症状重度 AS 患者的舒张功能。
在这项横断面研究中，对无症状、重度 AS 患者进行右心导管检查，在休息和中度运动时进行。患者还进行心肺运动测试以客观评估功能能力并确认无症状。
2019 年 2 月至 2021 年 5 月，我们纳入了 50 名年龄 70±12 岁的患者。患者存在严重的 AS，峰值速度为 4.4±0.4 m/s，平均梯度为 46±9 mm Hg，休息时指数化瓣口面积为 0.47±0.08 cm。所有患者均无症状且左心室射血分数正常。5 名患者在休息时存在毛细血管后肺动脉高压。在运动期间，44 名患者（88%）每增加 1 分钟心输出量，平均肺动脉压的增加>3 mm Hg/L，其中 93%的患者每增加 1 分钟心输出量，肺动脉楔压的增加>2 mm Hg/L，提示因左心疾病引起的运动性肺动脉高压。女性和年龄增长与肺动脉楔压增加与心输出量比值增加相关。导管插入术耐受性良好，无不良事件。
很大一部分无症状、退行性重度 AS 患者存在运动诱导的毛细血管后肺动脉高压。
