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Determinants and Prognostic Significance of Exercise Pulmonary Hypertension in Asymptomatic Severe Aortic Stenosis.
MedLine Citation:
PMID:  22832784     Owner:  NLM     Status:  Publisher    
BACKGROUND: Recent studies emphasized the usefulness of exercise stress echocardiography (ESE) in asymptomatic patients with aortic stenosis (AS). Nevertheless, the additive value of exercise pulmonary hypertension (Ex-PHT) in such patients remains unexplored. We, therefore, aimed to identify the determinants and to test the impact on outcome of Ex-PHT in asymptomatic patients with severe AS. METHOD AND RESULTS: Asymptomatic patients with severe AS (n=105, aortic valve area<0.6cm(2)/m(2), 71±9 years, 59% of male) and preserved left ventricular (LV) systolic function (ejection fraction≥55%) were prospectively submitted to ESE. Resting and ExPHT were defined as a systolic pulmonary arterial pressure (SPAP) >50mmHg and >60mmHg, respectively. Ex PHT was more frequent than resting PHT (55% vs. 6%, p<0.0001). On multivariable logistic regression, the independent predictors of ExPHT were male gender (odds-ratio [OR]=4.3, p=0.002), resting SPAP (OR=1.16, p=0.002), exercise indexed LV end-diastolic volume (OR=1.04, p=0.026), exercise e'-wave velocity (OR=1.35, p=0.047) and exercise-induced changes in indexed LA area (OR=1.36, p=0.006). Ex-PHT was associated with reduced cardiac event-free survival (3-year: 22±7 vs. 55±9%, p=0.014). In multivariable Cox proportional hazard model, Ex-PHT was identified as an independent predictor of cardiac events (hazard ratio [HR]=1.8, 95% confidence interval [CI]: 1.0-3.3, p=0.047). When adding exercise-induced changes in mean aortic pressure gradient to the multivariable model, Ex-PHT remained independently associated with reduced cardiac event-free survival (HR=2.0, 95%CI: 1.1-3.6, p=0.025). CONCLUSIONS: In asymptomatic patients with severe AS, the main determinants of Ex-PHT are male gender, resting SPAP and exercise parameters of diastolic burden. Moreover, Ex-PHT is associated with 2-fold increased risk of cardiac events. These results strongly support the use of ESE in asymptomatic AS.
Patrizio Lancellotti; Julien Magne; Erwan Donal; Kim O'Connor; Raluca Dulgheru; Monica Rosca; Luc A Pierard
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-7-25
Journal Detail:
Title:  Circulation     Volume:  -     ISSN:  1524-4539     ISO Abbreviation:  -     Publication Date:  2012 Jul 
Date Detail:
Created Date:  2012-7-26     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
1 University of Liège, University Hospital Sart Tilman, Liège, Belgium;
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