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Pressure–flow responses to exercise in aortic stenosis, mitral regurgitation and diastolic dysfunction
BACKGROUND: Haemodynamic exercise testing is important for evaluating patients with dyspnoea on exertion and preserved ejection fraction. Despite very different pathologies, patients with pressure (aortic stenosis (AS)) and volume (mitral regurgitation (MR)) overload and diastolic dysfunction after...
Autores principales: | , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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BMJ Publishing Group
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9664118/ https://www.ncbi.nlm.nih.gov/pubmed/36356959 http://dx.doi.org/10.1136/heartjnl-2022-321204 |
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author | Andersen, Mads J Wolsk, Emil Bakkestrøm, Rine Christensen, Nicolaj Carter-Storch, Rasmus Omar, Massar Dahl, Jordi S Frederiksen, Peter H Borlaug, Barry Gustafsson, Finn Hassager, Christian Moller, Jacob E |
author_facet | Andersen, Mads J Wolsk, Emil Bakkestrøm, Rine Christensen, Nicolaj Carter-Storch, Rasmus Omar, Massar Dahl, Jordi S Frederiksen, Peter H Borlaug, Barry Gustafsson, Finn Hassager, Christian Moller, Jacob E |
author_sort | Andersen, Mads J |
collection | PubMed |
description | BACKGROUND: Haemodynamic exercise testing is important for evaluating patients with dyspnoea on exertion and preserved ejection fraction. Despite very different pathologies, patients with pressure (aortic stenosis (AS)) and volume (mitral regurgitation (MR)) overload and diastolic dysfunction after recent acute myocardial infarction (AMI) reach similar filling pressure levels with exercise. The pressure–flow relationships (the association between change in cardiac output (∆CO) and change in pulmonary arterial wedge pressure (∆PAWP) may provide insight into haemodynamic adaptation to exercise in these groups. METHODS AND RESULTS: One hundred sixty-eight subjects aged >50 years with a left ventricular ejection fraction of ≥50% underwent invasive exercise testing. They were enrolled in four different studies: AS (40 patients), AMI (52 patients), MR (43 patients) and 33 healthy subjects. Haemodynamic data were measured at rest, at 25 W, 75 W and at peak exercise. In all groups, PAWP increased with exercise. The greatest increase was observed in patients with AMI (from 12.7±3.9 mm Hg to 33.1±8.2 mm Hg, p<0.0001) and patients with AS (from 11.8±3.9 mm Hg to 31.4±6.1 mm Hg, p<0.0001), and the smallest was observed in healthy subjects (from 8.3±2.4 mm Hg to 21.1±7.5 mm Hg, p<0.0001). In all groups, the relative pressure increase was greatest at the beginning of the exercise. CO increased most in healthy patients (from 5.3±1.1 to 16.0±3.0 L/min, p<0.0001) and least in patients with AS (from 5.3±1.2 L/min to 12.4±2.6 L/min, p<0.0001). The pressure–flow relationships (∆PAWP/∆CO) and differed among groups (p=0.02). In all groups, the pressure–flow relationship was steepest in the initial phase of the exercise test. The AMI and AS groups (2.3±1.2 mm Hg/L/min and 3.0±1.3 mm Hg/L/min, AMI and AS, respectively) had the largest overall pressure–flow relationship; the healthy group had the smallest initially and at peak exercise (1.3±1.1 mm Hg/L/min) followed by MR group (1.9±1.4 mm Hg/L/min). CONCLUSION: The pressure–flow relationship was steepest in the initial phase of the exercise test in all groups. The pressure–flow relationship differs between groups. TRIAL REGISTRATION NUMBERS: NCT01974557, NCT01046838, NCT02961647 and NCT02395107. |
format | Online Article Text |
id | pubmed-9664118 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-96641182022-11-15 Pressure–flow responses to exercise in aortic stenosis, mitral regurgitation and diastolic dysfunction Andersen, Mads J Wolsk, Emil Bakkestrøm, Rine Christensen, Nicolaj Carter-Storch, Rasmus Omar, Massar Dahl, Jordi S Frederiksen, Peter H Borlaug, Barry Gustafsson, Finn Hassager, Christian Moller, Jacob E Heart Heart Failure and Cardiomyopathies BACKGROUND: Haemodynamic exercise testing is important for evaluating patients with dyspnoea on exertion and preserved ejection fraction. Despite very different pathologies, patients with pressure (aortic stenosis (AS)) and volume (mitral regurgitation (MR)) overload and diastolic dysfunction after recent acute myocardial infarction (AMI) reach similar filling pressure levels with exercise. The pressure–flow relationships (the association between change in cardiac output (∆CO) and change in pulmonary arterial wedge pressure (∆PAWP) may provide insight into haemodynamic adaptation to exercise in these groups. METHODS AND RESULTS: One hundred sixty-eight subjects aged >50 years with a left ventricular ejection fraction of ≥50% underwent invasive exercise testing. They were enrolled in four different studies: AS (40 patients), AMI (52 patients), MR (43 patients) and 33 healthy subjects. Haemodynamic data were measured at rest, at 25 W, 75 W and at peak exercise. In all groups, PAWP increased with exercise. The greatest increase was observed in patients with AMI (from 12.7±3.9 mm Hg to 33.1±8.2 mm Hg, p<0.0001) and patients with AS (from 11.8±3.9 mm Hg to 31.4±6.1 mm Hg, p<0.0001), and the smallest was observed in healthy subjects (from 8.3±2.4 mm Hg to 21.1±7.5 mm Hg, p<0.0001). In all groups, the relative pressure increase was greatest at the beginning of the exercise. CO increased most in healthy patients (from 5.3±1.1 to 16.0±3.0 L/min, p<0.0001) and least in patients with AS (from 5.3±1.2 L/min to 12.4±2.6 L/min, p<0.0001). The pressure–flow relationships (∆PAWP/∆CO) and differed among groups (p=0.02). In all groups, the pressure–flow relationship was steepest in the initial phase of the exercise test. The AMI and AS groups (2.3±1.2 mm Hg/L/min and 3.0±1.3 mm Hg/L/min, AMI and AS, respectively) had the largest overall pressure–flow relationship; the healthy group had the smallest initially and at peak exercise (1.3±1.1 mm Hg/L/min) followed by MR group (1.9±1.4 mm Hg/L/min). CONCLUSION: The pressure–flow relationship was steepest in the initial phase of the exercise test in all groups. The pressure–flow relationship differs between groups. TRIAL REGISTRATION NUMBERS: NCT01974557, NCT01046838, NCT02961647 and NCT02395107. BMJ Publishing Group 2022-12 2022-08-29 /pmc/articles/PMC9664118/ /pubmed/36356959 http://dx.doi.org/10.1136/heartjnl-2022-321204 Text en © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) . |
spellingShingle | Heart Failure and Cardiomyopathies Andersen, Mads J Wolsk, Emil Bakkestrøm, Rine Christensen, Nicolaj Carter-Storch, Rasmus Omar, Massar Dahl, Jordi S Frederiksen, Peter H Borlaug, Barry Gustafsson, Finn Hassager, Christian Moller, Jacob E Pressure–flow responses to exercise in aortic stenosis, mitral regurgitation and diastolic dysfunction |
title | Pressure–flow responses to exercise in aortic stenosis, mitral regurgitation and diastolic dysfunction |
title_full | Pressure–flow responses to exercise in aortic stenosis, mitral regurgitation and diastolic dysfunction |
title_fullStr | Pressure–flow responses to exercise in aortic stenosis, mitral regurgitation and diastolic dysfunction |
title_full_unstemmed | Pressure–flow responses to exercise in aortic stenosis, mitral regurgitation and diastolic dysfunction |
title_short | Pressure–flow responses to exercise in aortic stenosis, mitral regurgitation and diastolic dysfunction |
title_sort | pressure–flow responses to exercise in aortic stenosis, mitral regurgitation and diastolic dysfunction |
topic | Heart Failure and Cardiomyopathies |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9664118/ https://www.ncbi.nlm.nih.gov/pubmed/36356959 http://dx.doi.org/10.1136/heartjnl-2022-321204 |
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