Department of Cardiothoracic and Vascular surgery, and Department of Health, Medicine and Caring Sciences, Linkoping University Faculty of Medicine, Linkoping, Sweden
Department of Clinical Physiology, and Department of Health, Medicine and Caring Sciences, Linkoping University Faculty of Medicine, Linkoping, Sweden.
Open Heart. 2024 Nov 9;11(2):e002786. doi: 10.1136/openhrt-2024-002786.
Knowledge about how patients with symptomatic aortic stenosis (AS) perform on cardiopulmonary exercise testing (CPET) is sparse. Since exercise testing in patients with symptomatic AS is not advised, submaximal parameters could be of special interest. We aimed to investigate maximal and submaximal physical capacity by CPET before and 1 year after surgical aortic valve replacement (sAVR) in patients with severe AS.
In this prospective longitudinal study, 30 adult patients (age 66±10 years) with severe AS referred for sAVR underwent maximal CPET (respiratory exchange ratio ≥1.05) on a bicycle ergometer before (PRE) and 1 year after (POST) sAVR. Normally distributed data are presented as mean (±SD) and non-normally distributed data are presented as median (IQR).
Median peak workload increased by 8% from 133 (55) watts at PRE to 144 (67) watts at POST (p<0.001). Median ventilatory threshold (VO@VT) increased from 1216 (391) to 1328 (309) mL/min (p=0.001, n=28). Mean peak oxygen uptake (peakVO) was not significantly different between PRE and POST; 1871±441 vs 1937±404 mL/min (p=0.08). The oxygen uptake efficacy slope (OUES) was significantly correlated to PeakVO2 at both PRE (r=0.889, p<0.05) and POST (r=0.888, p<0.05) CONCLUSION: Physical work capacity was improved 1 year following sAVR, in terms of higher median peak workload and VO@VT. The strong correlation between the submaximal variable OUES and peakVO suggests that OUES might be a useful surrogate of peakVO in this group of patients where maximal exercise testing is not always recommended.
关于有症状的主动脉瓣狭窄（AS）患者在心肺运动测试（CPET）中的表现，相关知识较为匮乏。由于不建议对有症状的 AS 患者进行运动测试，因此亚极量参数可能具有特殊意义。我们旨在研究严重 AS 患者在主动脉瓣置换术（sAVR）前后 CPET 的最大和亚极量体力能力。
在这项前瞻性纵向研究中，30 名年龄 66±10 岁的成人严重 AS 患者在接受 sAVR 之前（PRE）和之后 1 年（POST）进行了自行车测力计的最大 CPET（呼吸交换率≥1.05）。正态分布数据以均数（±标准差）表示，非正态分布数据以中位数（IQR）表示。
中位峰值工作负荷从 PRE 时的 133（55）瓦特增加到 POST 时的 144（67）瓦特，增加了 8%（p<0.001）。中位通气阈值（VO@VT）从 1216（391）增加到 1328（309）mL/min（p=0.001，n=28）。PEAKVO 在 PRE 和 POST 之间没有显著差异；1871±441 vs 1937±404 mL/min（p=0.08）。PEAKVO 的摄氧效率斜率（OUES）在 PRE（r=0.889，p<0.05）和 POST（r=0.888，p<0.05）时均与摄氧量显著相关。
sAVR 后 1 年，中位峰值工作负荷和 VO@VT 均有所提高，体力能力得到改善。亚极量变量 OUES 与 PeakVO 之间的强相关性表明，在不建议对该组患者进行最大运动测试的情况下，OUES 可能是 PeakVO 的有用替代指标。
