In moderate AS patients, lower coronary flow velocity reserve, lower stroke volume index, higher BNP, and lower PTH are linked to reduced functional capacity (pVO2 ≤14).
Are imaging and biohumoral markers associated with reduced functional capacity in patients with moderate aortic stenosis and preserved LVEF?
Impaired myocardial flow reserve and altered mineral metabolism are associated with reduced functional capacity in patients with moderate aortic stenosis and preserved LVEF.
Absolute Event Rate: 0% vs 0%
Abstract Background Aortic stenosis (AS) is an active disease of the valve and myocardium. Lipoprotein components and calcium are deposited, similar to coronary artery atherosclerosis. In AS patients, left ventricular hypertrophy only weakly correlates with the degree of valve obstruction. It is common for AS to produce no symptoms or only minor symptoms until it becomes severe. By the time symptoms appear myocardial damage may have already occurred. Noninvasive measures of subclinical LV dysfunction may offer promise for identifying at-risk patients with moderate AS in the earliest stages. In asymptomatic or equivocally symptomatic patients Cardiopulmonary exercise test (CPET) reflects an objective measure of functional capacity (pVO2) and explains its physiology. Additionally, blood biomarkers can provide information regarding adverse changes in the left ventricle (LV) structure and function. Purpose To examine predictors of reduced functional capacity in patients with moderate AS and preserved left ventricular ejection fraction (LVEF) by imaging methods and blood biomarkers of inflammatory, lipid, and mineral metabolism. Methods 63 patients underwent a comprehensive echo study with myocardial work analysis, MDCT coronary angiography with calcium scoring, laboratory blood testing, Coronary flow velocity reserve (CFVR) by transthoracic Doppler echocardiography for left anterior descendent artery (LAD) and cardiopulmonary stress test (CPET). In 4 patients significant coronary artery disease was detected. 59 were included in the analysis (age 73±6, 59% male). Patients were then divided into 2 groups based on their peak V̇o2: Patients were divided into group 1 and group 2 according to their exercise peak oxygen uptake (pVO2) (group 1: peak VO2 ≤14 mL/kg/min, group 2: peak VO2 14 mL/kg/min). Results The main results are shown in Table. There were no significant differences in standard echocardiography and strain-based measurements between the pVO2≤14 and pVO2 14 groups. except indexed stroke volume (SVi) which was lower in the pVO2≤14 group. CVFR LAD was also significantly lower in the pVO2≤14 group. Blood biomarker of myocardial wall stretch brain-type natriuretic peptide (BNP) was higher and calcium metabolism Parathyroid hormone (PTH) was lower in the pVO2≤14 group. Conclusion In patients with moderate aortic stenosis AS and non-obstructive coronary artery disease, impaired myocardial flow reserve and impaired mineral metabolism are associated with reduced functional capacity
Petrovic et al. (Sat,) reported a other. In moderate AS patients, lower coronary flow velocity reserve, lower stroke volume index, higher BNP, and lower PTH are linked to reduced functional capacity (pVO2 ≤14).
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