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Determinants of exercise tolerance in aortic stenosis
Session:
Painel 9 - Doença Valvular 1
Speaker:
Paula Fazendas
Congress:
CPC 2020
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
15. Valvular Heart Disease
Subtheme:
15.3 Valvular Heart Disease – Diagnostic Methods
Session Type:
Posters
FP Number:
---
Authors:
Paula Fazendas; Ana Francisco; Angela Manuel; H. Pereira; Ana G. Almeida
Abstract
<p>Introduction: A variation of 20 mmHg in the mean aortic gradient (MAG) in asymptomatic aortic stenosis (AS) was proposed as an indicator of severity during exercise echocardiography.</p> <p>Objective: to identify echocardiographic predictors of exercise tolerance in AS and analyze the association of the variation in MAG with exercise tolerance.</p> <p>Methods: prospective study of patients (pts) referred for testing with asymptomatic AS. We performed exercise echocardiography (EE) using the modified Bruce Protocol. Baseline, peak and recovery imaging was performed. Exercise tolerance (ExT) was expressed as METS and % of predicted METS for age and sex (PExT). </p> <p>Population: 24 pts, 14 males, age 72±9 years, body mass index (BMI): 28±4 Kg/m2, etiology: bicuspid 6 pts, tricuspid 18 pts, 20 pts were in sinus rhythm and 4 in atrial fibrillation (AF).</p> <p>Results: baseline parameters: indexed aortic valve area (AVAi): 0,51±0,13cm2/m2, MAG 37±12mmHg, left ventricle ejection fraction (LVEF): 63±9%, cardiac index (CI) 3,2±0,6L/min/m<sup>2</sup>, global longitudinal strain (LVGLS) -16±3%, VTI ratio: 0,26±0,05, valvulo-arterial impedance (Zva): 3,9±0,9mmHg.ml<sup>-1</sup>.m<sup>2</sup>. Peak parameters: AVAi: 0,54±0,14 cm2/m2, MAG 53±17 mmHg, LVEF: 69 (IQR10)%, CI 3,2±0,6, LVGLS -19±5%, VTI ratio: 0,28±0,06, Zva: 4,3±1,4, ExT: METS 6±2, representing 86±26% of the PExT; 10 patients had MAG increments >20 mmHg with exercise.</p> <p>Pts who had MAG increments > 20 mmHg had higher ExT (METS 7±2,2 vs 5,6±2,4; Cohen’s <em>d</em>=0,66). A higher peak CI correlated with a higher ExT (r=0,5, p 0,01) and higher MAG variation (r=0,6 p<0,01). Age was also associated with ExT (r=-0,43, p<0,05). We found no association of rest parameters of AS severity such as AVA, AVAi, VTI ratio, LVEF with ExT. In this sample the presence of AF showed no influence in ExT. Pts with bicuspid AS had higher absolute ExT (METS 8±2,5 vs 5,5±2, p<0,05) but that was explained by the lower age given that the PExT was similar (88% vs 86% p=ns).</p> <p>The strongest predictor was the peak CI (B coefficient 0,5, R=0,75, R2 0,57): when corrected for age, sex and BMI, for each increase of 0,5 mL/min/m2 in the peak CI is expected an increase of 1 MET. This model explains 57 % of the variation in exercise capacity in these patients.</p> <p>Conclusions: higher mean aortic gradient variation is associated with higher exercise tolerance and the strongest determinant of exercise tolerance in AS is the peak CI.</p>
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