Background: Aortic stenosis (AS) is characterized by increased afterload and functional disability. Exercise intolerance may incur even without overt symptoms. Cardiopulmonary exercise testing (CPET) provides pathophysiological insights on mechanisms affecting exercise intolerance. Nonetheless, it has never been used in the past for assessing this specific disorder. We hypothesized that a flattening in the incremental oxygen consumption over work rate may well reflect the degree of hemodynamic and cardiac output impairment. Methods: 31 patients with moderate-to-severe AS underwent a maximal CPET (personalized ramp protocol) combined with Echo-Doppler assessment. Results: We considered 2 subgroups according to the occurrence of ∆VO2/∆WR flattening, defined as a change >20% of the slope during exercise. Patients who showed ∆VO2/∆WR flattening had higher transaortic gradients (78% mean gradient >40 mmHg), more severe mitral regurgitation, worse ventilation efficiency, a trend toward elevated systolic pulmonary pressures, reduced peak VO2 and dilated left atrium. Conclusion: In AS, for similar symptomatic state, a flattened ∆VO2/∆WR identifies highest aortic gradients and true cardiac limitation to exercise, associated with an increased prevalence of ventilatory inefficiency. Finding suggests the additive ability of CPET to better unmask aortic AS phenotypes.

Assessing exercise performance by combining cardiopulmonary test to stress echo in aortic stenosis / M. Guazzi, M. Pellegrino, G. Generati, V. Donghi, E. Alfonzetti, F. Bandera. ((Intervento presentato al convegno ACC Annual Scientific Session tenutosi a Washington DC nel 2014.

Assessing exercise performance by combining cardiopulmonary test to stress echo in aortic stenosis

M. Guazzi;V. Donghi;F. Bandera
2014-04

Abstract

Background: Aortic stenosis (AS) is characterized by increased afterload and functional disability. Exercise intolerance may incur even without overt symptoms. Cardiopulmonary exercise testing (CPET) provides pathophysiological insights on mechanisms affecting exercise intolerance. Nonetheless, it has never been used in the past for assessing this specific disorder. We hypothesized that a flattening in the incremental oxygen consumption over work rate may well reflect the degree of hemodynamic and cardiac output impairment. Methods: 31 patients with moderate-to-severe AS underwent a maximal CPET (personalized ramp protocol) combined with Echo-Doppler assessment. Results: We considered 2 subgroups according to the occurrence of ∆VO2/∆WR flattening, defined as a change >20% of the slope during exercise. Patients who showed ∆VO2/∆WR flattening had higher transaortic gradients (78% mean gradient >40 mmHg), more severe mitral regurgitation, worse ventilation efficiency, a trend toward elevated systolic pulmonary pressures, reduced peak VO2 and dilated left atrium. Conclusion: In AS, for similar symptomatic state, a flattened ∆VO2/∆WR identifies highest aortic gradients and true cardiac limitation to exercise, associated with an increased prevalence of ventilatory inefficiency. Finding suggests the additive ability of CPET to better unmask aortic AS phenotypes.
Settore MED/11 - Malattie dell'Apparato Cardiovascolare
American College of Cardiology
Assessing exercise performance by combining cardiopulmonary test to stress echo in aortic stenosis / M. Guazzi, M. Pellegrino, G. Generati, V. Donghi, E. Alfonzetti, F. Bandera. ((Intervento presentato al convegno ACC Annual Scientific Session tenutosi a Washington DC nel 2014.
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/2434/238708
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