Sarah Hoedemakers, Nicola Riccardo Pugliese, Jan Stassen, Arnaud Vanoppen, Jade Claessens, Tin Gojevic, Youri Bekhuis, Maarten Falter, Sara Moura Ferreira, Sebastiaan Dhont, Nicolò De Biase, Lavinia Del Punta, Valerio Di Fiore, Marco De Carlo, Cristina Giannini, Andrea Colli, Raluca Elena Dulgheru, Jolien Geers, Alaaddin Yilmaz, Guido Claessen, Philippe Bertrand, Steven Droogmans, Patrizio Lancellotti, Bernard Cosyns, Frederik H Verbrugge, Lieven Herbots, Stefano Masi, Jan Verwerft
{"title":"mPAP/CO 斜率和摄氧量增加了主动脉瓣狭窄的预后价值。","authors":"Sarah Hoedemakers, Nicola Riccardo Pugliese, Jan Stassen, Arnaud Vanoppen, Jade Claessens, Tin Gojevic, Youri Bekhuis, Maarten Falter, Sara Moura Ferreira, Sebastiaan Dhont, Nicolò De Biase, Lavinia Del Punta, Valerio Di Fiore, Marco De Carlo, Cristina Giannini, Andrea Colli, Raluca Elena Dulgheru, Jolien Geers, Alaaddin Yilmaz, Guido Claessen, Philippe Bertrand, Steven Droogmans, Patrizio Lancellotti, Bernard Cosyns, Frederik H Verbrugge, Lieven Herbots, Stefano Masi, Jan Verwerft","doi":"10.1161/CIRCULATIONAHA.123.067130","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Recent guidelines redefined exercise pulmonary hypertension as a mean pulmonary artery pressure/cardiac output (mPAP/CO) slope >3 mm Hg·L<sup>-1</sup>·min<sup>-1</sup>. A peak systolic pulmonary artery pressure >60 mm Hg during exercise has been associated with an increased risk of cardiovascular death, heart failure rehospitalization, and aortic valve replacement in aortic valve stenosis. The prognostic value of the mPAP/CO slope in aortic valve stenosis remains unknown.</p><p><strong>Methods: </strong>In this prospective cohort study, consecutive patients (n=143; age, 73±11 years) with an aortic valve area ≤1.5 cm<sup>2</sup> underwent cardiopulmonary exercise testing with echocardiography. They were subsequently evaluated for the occurrence of cardiovascular events (ie, cardiovascular death, heart failure hospitalization, new-onset atrial fibrillation, and aortic valve replacement) during a follow-up period of 1 year. Findings were externally validated (validation cohort, n=141).</p><p><strong>Results: </strong>One cardiovascular death, 32 aortic valve replacements, 9 new-onset atrial fibrillation episodes, and 4 heart failure hospitalizations occurred in the derivation cohort, whereas 5 cardiovascular deaths, 32 aortic valve replacements, 1 new-onset atrial fibrillation episode, and 10 heart failure hospitalizations were observed in the validation cohort. Peak aortic velocity (odds ratio [OR] per SD, 1.48; <i>P</i>=0.036), indexed left atrial volume (OR per SD, 2.15; <i>P</i>=0.001), E/e' at rest (OR per SD, 1.61; <i>P</i>=0.012), mPAP/CO slope (OR per SD, 2.01; <i>P</i>=0.002), and age-, sex-, and height-based predicted peak exercise oxygen uptake (OR per SD, 0.59; <i>P</i>=0.007) were independently associated with cardiovascular events at 1 year, whereas peak systolic pulmonary artery pressure was not (OR per SD, 1.28; <i>P</i>=0.219). Peak Vo<sub>2</sub> (percent) and mPAP/CO slope provided incremental prognostic value in addition to indexed left atrial volume and aortic valve area (<i>P</i><0.001). These results were confirmed in the validation cohort.</p><p><strong>Conclusions: </strong>In moderate and severe aortic valve stenosis, mPAP/CO slope and percent-predicted peak Vo<sub>2</sub> were independent predictors of cardiovascular events, whereas peak systolic pulmonary artery pressure was not. In addition to aortic valve area and indexed left atrial volume, percent-predicted peak Vo<sub>2</sub> and mPAP/CO slope cumulatively improved risk stratification.</p>","PeriodicalId":10331,"journal":{"name":"Circulation","volume":" ","pages":"1172-1182"},"PeriodicalIF":35.5000,"publicationDate":"2024-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"mPAP/CO Slope and Oxygen Uptake Add Prognostic Value in Aortic Stenosis.\",\"authors\":\"Sarah Hoedemakers, Nicola Riccardo Pugliese, Jan Stassen, Arnaud Vanoppen, Jade Claessens, Tin Gojevic, Youri Bekhuis, Maarten Falter, Sara Moura Ferreira, Sebastiaan Dhont, Nicolò De Biase, Lavinia Del Punta, Valerio Di Fiore, Marco De Carlo, Cristina Giannini, Andrea Colli, Raluca Elena Dulgheru, Jolien Geers, Alaaddin Yilmaz, Guido Claessen, Philippe Bertrand, Steven Droogmans, Patrizio Lancellotti, Bernard Cosyns, Frederik H Verbrugge, Lieven Herbots, Stefano Masi, Jan Verwerft\",\"doi\":\"10.1161/CIRCULATIONAHA.123.067130\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Recent guidelines redefined exercise pulmonary hypertension as a mean pulmonary artery pressure/cardiac output (mPAP/CO) slope >3 mm Hg·L<sup>-1</sup>·min<sup>-1</sup>. A peak systolic pulmonary artery pressure >60 mm Hg during exercise has been associated with an increased risk of cardiovascular death, heart failure rehospitalization, and aortic valve replacement in aortic valve stenosis. The prognostic value of the mPAP/CO slope in aortic valve stenosis remains unknown.</p><p><strong>Methods: </strong>In this prospective cohort study, consecutive patients (n=143; age, 73±11 years) with an aortic valve area ≤1.5 cm<sup>2</sup> underwent cardiopulmonary exercise testing with echocardiography. They were subsequently evaluated for the occurrence of cardiovascular events (ie, cardiovascular death, heart failure hospitalization, new-onset atrial fibrillation, and aortic valve replacement) during a follow-up period of 1 year. Findings were externally validated (validation cohort, n=141).</p><p><strong>Results: </strong>One cardiovascular death, 32 aortic valve replacements, 9 new-onset atrial fibrillation episodes, and 4 heart failure hospitalizations occurred in the derivation cohort, whereas 5 cardiovascular deaths, 32 aortic valve replacements, 1 new-onset atrial fibrillation episode, and 10 heart failure hospitalizations were observed in the validation cohort. Peak aortic velocity (odds ratio [OR] per SD, 1.48; <i>P</i>=0.036), indexed left atrial volume (OR per SD, 2.15; <i>P</i>=0.001), E/e' at rest (OR per SD, 1.61; <i>P</i>=0.012), mPAP/CO slope (OR per SD, 2.01; <i>P</i>=0.002), and age-, sex-, and height-based predicted peak exercise oxygen uptake (OR per SD, 0.59; <i>P</i>=0.007) were independently associated with cardiovascular events at 1 year, whereas peak systolic pulmonary artery pressure was not (OR per SD, 1.28; <i>P</i>=0.219). Peak Vo<sub>2</sub> (percent) and mPAP/CO slope provided incremental prognostic value in addition to indexed left atrial volume and aortic valve area (<i>P</i><0.001). These results were confirmed in the validation cohort.</p><p><strong>Conclusions: </strong>In moderate and severe aortic valve stenosis, mPAP/CO slope and percent-predicted peak Vo<sub>2</sub> were independent predictors of cardiovascular events, whereas peak systolic pulmonary artery pressure was not. In addition to aortic valve area and indexed left atrial volume, percent-predicted peak Vo<sub>2</sub> and mPAP/CO slope cumulatively improved risk stratification.</p>\",\"PeriodicalId\":10331,\"journal\":{\"name\":\"Circulation\",\"volume\":\" \",\"pages\":\"1172-1182\"},\"PeriodicalIF\":35.5000,\"publicationDate\":\"2024-04-09\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Circulation\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1161/CIRCULATIONAHA.123.067130\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/2/27 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q1\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Circulation","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1161/CIRCULATIONAHA.123.067130","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/2/27 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
mPAP/CO Slope and Oxygen Uptake Add Prognostic Value in Aortic Stenosis.
Background: Recent guidelines redefined exercise pulmonary hypertension as a mean pulmonary artery pressure/cardiac output (mPAP/CO) slope >3 mm Hg·L-1·min-1. A peak systolic pulmonary artery pressure >60 mm Hg during exercise has been associated with an increased risk of cardiovascular death, heart failure rehospitalization, and aortic valve replacement in aortic valve stenosis. The prognostic value of the mPAP/CO slope in aortic valve stenosis remains unknown.
Methods: In this prospective cohort study, consecutive patients (n=143; age, 73±11 years) with an aortic valve area ≤1.5 cm2 underwent cardiopulmonary exercise testing with echocardiography. They were subsequently evaluated for the occurrence of cardiovascular events (ie, cardiovascular death, heart failure hospitalization, new-onset atrial fibrillation, and aortic valve replacement) during a follow-up period of 1 year. Findings were externally validated (validation cohort, n=141).
Results: One cardiovascular death, 32 aortic valve replacements, 9 new-onset atrial fibrillation episodes, and 4 heart failure hospitalizations occurred in the derivation cohort, whereas 5 cardiovascular deaths, 32 aortic valve replacements, 1 new-onset atrial fibrillation episode, and 10 heart failure hospitalizations were observed in the validation cohort. Peak aortic velocity (odds ratio [OR] per SD, 1.48; P=0.036), indexed left atrial volume (OR per SD, 2.15; P=0.001), E/e' at rest (OR per SD, 1.61; P=0.012), mPAP/CO slope (OR per SD, 2.01; P=0.002), and age-, sex-, and height-based predicted peak exercise oxygen uptake (OR per SD, 0.59; P=0.007) were independently associated with cardiovascular events at 1 year, whereas peak systolic pulmonary artery pressure was not (OR per SD, 1.28; P=0.219). Peak Vo2 (percent) and mPAP/CO slope provided incremental prognostic value in addition to indexed left atrial volume and aortic valve area (P<0.001). These results were confirmed in the validation cohort.
Conclusions: In moderate and severe aortic valve stenosis, mPAP/CO slope and percent-predicted peak Vo2 were independent predictors of cardiovascular events, whereas peak systolic pulmonary artery pressure was not. In addition to aortic valve area and indexed left atrial volume, percent-predicted peak Vo2 and mPAP/CO slope cumulatively improved risk stratification.
期刊介绍：
Circulation is a platform that publishes a diverse range of content related to cardiovascular health and disease. This includes original research manuscripts, review articles, and other contributions spanning observational studies, clinical trials, epidemiology, health services, outcomes studies, and advancements in basic and translational research. The journal serves as a vital resource for professionals and researchers in the field of cardiovascular health, providing a comprehensive platform for disseminating knowledge and fostering advancements in the understanding and management of cardiovascular issues.
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