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Myocardial Oxygen Consumption and Efficiency in Aortic Valve Stenosis Patients With and Without Heart Failure

BACKGROUND: Myocardial oxygen consumption (MVO(2)) and its coupling to contractile work are fundamentals of cardiac function and may be involved causally in the transition from compensated left ventricular hypertrophy to failure. Nevertheless, these processes have not been studied previously in pati...

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Autores principales: Hansson, Nils Henrik Stubkjær, Sörensen, Jens, Harms, Hendrik Johannes, Kim, Won Yong, Nielsen, Roni, Tolbod, Lars P., Frøkiær, Jørgen, Bouchelouche, Kirsten, Dodt, Karen Kaae, Sihm, Inger, Poulsen, Steen Hvitfeldt, Wiggers, Henrik
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5523773/
https://www.ncbi.nlm.nih.gov/pubmed/28167498
http://dx.doi.org/10.1161/JAHA.116.004810
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author Hansson, Nils Henrik Stubkjær
Sörensen, Jens
Harms, Hendrik Johannes
Kim, Won Yong
Nielsen, Roni
Tolbod, Lars P.
Frøkiær, Jørgen
Bouchelouche, Kirsten
Dodt, Karen Kaae
Sihm, Inger
Poulsen, Steen Hvitfeldt
Wiggers, Henrik
author_facet Hansson, Nils Henrik Stubkjær
Sörensen, Jens
Harms, Hendrik Johannes
Kim, Won Yong
Nielsen, Roni
Tolbod, Lars P.
Frøkiær, Jørgen
Bouchelouche, Kirsten
Dodt, Karen Kaae
Sihm, Inger
Poulsen, Steen Hvitfeldt
Wiggers, Henrik
author_sort Hansson, Nils Henrik Stubkjær
collection PubMed
description BACKGROUND: Myocardial oxygen consumption (MVO(2)) and its coupling to contractile work are fundamentals of cardiac function and may be involved causally in the transition from compensated left ventricular hypertrophy to failure. Nevertheless, these processes have not been studied previously in patients with aortic valve stenosis (AS). METHODS AND RESULTS: Participants underwent (11)C‐acetate positron emission tomography, cardiovascular magnetic resonance, and echocardiography to measure MVO(2) and myocardial external efficiency (MEE) defined as the ratio of left ventricular stroke work and the energy equivalent of MVO(2). We studied 10 healthy controls (group A), 37 asymptomatic AS patients with left ventricular ejection fraction ≥50% (group B), 12 symptomatic AS patients with left ventricular ejection fraction ≥50% (group C), and 9 symptomatic AS patients with left ventricular ejection fraction <50% (group D). MVO(2) did not differ among groups A, B, C, and D (0.105±0.02, 0.117±0.024, 0.129±0.032, and 0.104±0.026 mL/min per gram, respectively; P=0.07), whereas MEE was reduced in group D (21.0±1.6%, 22.3±3.3%, 22.1±4.2%, and 17.3±4.7%, respectively; P<0.05). Similarly, patients with global longitudinal strain greater than −12% and paradoxical low‐flow, low‐gradient AS had impaired MEE (P<0.05 versus controls). The ability to discriminate between symptomatic and asymptomatic patients was superior for global longitudinal strain compared with MVO(2) and MEE (area under the curve 0.98, 0.48, and 0.61, respectively; P<0.05). CONCLUSIONS: AS patients display a persistent ability to maintain normal MVO(2) and MEE (ie, the ability to convert energy into stroke work); however, patients with left ventricular ejection fraction <50%; global longitudinal strain greater than −12%; or paradoxical low‐flow, low‐gradient AS demonstrate reduced MEE. These findings suggest that mitochondrial uncoupling contributes to the dismal prognosis in patients with reduced contractile function or paradoxical low‐flow, low‐gradient AS.
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spelling pubmed-55237732017-08-14 Myocardial Oxygen Consumption and Efficiency in Aortic Valve Stenosis Patients With and Without Heart Failure Hansson, Nils Henrik Stubkjær Sörensen, Jens Harms, Hendrik Johannes Kim, Won Yong Nielsen, Roni Tolbod, Lars P. Frøkiær, Jørgen Bouchelouche, Kirsten Dodt, Karen Kaae Sihm, Inger Poulsen, Steen Hvitfeldt Wiggers, Henrik J Am Heart Assoc Original Research BACKGROUND: Myocardial oxygen consumption (MVO(2)) and its coupling to contractile work are fundamentals of cardiac function and may be involved causally in the transition from compensated left ventricular hypertrophy to failure. Nevertheless, these processes have not been studied previously in patients with aortic valve stenosis (AS). METHODS AND RESULTS: Participants underwent (11)C‐acetate positron emission tomography, cardiovascular magnetic resonance, and echocardiography to measure MVO(2) and myocardial external efficiency (MEE) defined as the ratio of left ventricular stroke work and the energy equivalent of MVO(2). We studied 10 healthy controls (group A), 37 asymptomatic AS patients with left ventricular ejection fraction ≥50% (group B), 12 symptomatic AS patients with left ventricular ejection fraction ≥50% (group C), and 9 symptomatic AS patients with left ventricular ejection fraction <50% (group D). MVO(2) did not differ among groups A, B, C, and D (0.105±0.02, 0.117±0.024, 0.129±0.032, and 0.104±0.026 mL/min per gram, respectively; P=0.07), whereas MEE was reduced in group D (21.0±1.6%, 22.3±3.3%, 22.1±4.2%, and 17.3±4.7%, respectively; P<0.05). Similarly, patients with global longitudinal strain greater than −12% and paradoxical low‐flow, low‐gradient AS had impaired MEE (P<0.05 versus controls). The ability to discriminate between symptomatic and asymptomatic patients was superior for global longitudinal strain compared with MVO(2) and MEE (area under the curve 0.98, 0.48, and 0.61, respectively; P<0.05). CONCLUSIONS: AS patients display a persistent ability to maintain normal MVO(2) and MEE (ie, the ability to convert energy into stroke work); however, patients with left ventricular ejection fraction <50%; global longitudinal strain greater than −12%; or paradoxical low‐flow, low‐gradient AS demonstrate reduced MEE. These findings suggest that mitochondrial uncoupling contributes to the dismal prognosis in patients with reduced contractile function or paradoxical low‐flow, low‐gradient AS. John Wiley and Sons Inc. 2017-02-06 /pmc/articles/PMC5523773/ /pubmed/28167498 http://dx.doi.org/10.1161/JAHA.116.004810 Text en © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell. This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial‐NoDerivs (http://creativecommons.org/licenses/by-nc-nd/4.0/) License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
spellingShingle Original Research
Hansson, Nils Henrik Stubkjær
Sörensen, Jens
Harms, Hendrik Johannes
Kim, Won Yong
Nielsen, Roni
Tolbod, Lars P.
Frøkiær, Jørgen
Bouchelouche, Kirsten
Dodt, Karen Kaae
Sihm, Inger
Poulsen, Steen Hvitfeldt
Wiggers, Henrik
Myocardial Oxygen Consumption and Efficiency in Aortic Valve Stenosis Patients With and Without Heart Failure
title Myocardial Oxygen Consumption and Efficiency in Aortic Valve Stenosis Patients With and Without Heart Failure
title_full Myocardial Oxygen Consumption and Efficiency in Aortic Valve Stenosis Patients With and Without Heart Failure
title_fullStr Myocardial Oxygen Consumption and Efficiency in Aortic Valve Stenosis Patients With and Without Heart Failure
title_full_unstemmed Myocardial Oxygen Consumption and Efficiency in Aortic Valve Stenosis Patients With and Without Heart Failure
title_short Myocardial Oxygen Consumption and Efficiency in Aortic Valve Stenosis Patients With and Without Heart Failure
title_sort myocardial oxygen consumption and efficiency in aortic valve stenosis patients with and without heart failure
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5523773/
https://www.ncbi.nlm.nih.gov/pubmed/28167498
http://dx.doi.org/10.1161/JAHA.116.004810
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