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Exercise Mildly Increases Transaortic Gradients in Aortic Stenosis With Preserved Ejection Fraction: An Invasive

Abdullah Al-Abcha1, C Charles Jain1, Rick A Nishimura1

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Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
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Summary

Hemodynamic exercise testing in aortic stenosis (AS) shows a small increase in aortic valve mean gradient and area, but no significant rise in stroke volume. Exercise also commonly elevates filling pressures in symptomatic patients with moderate AS.

Keywords:
aortic stenosiscardiac catheterizationexercisehemodynamics

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Area of Science:

  • Cardiology
  • Cardiovascular Physiology
  • Clinical Hemodynamics

Background:

  • Assessing aortic stenosis (AS) severity can be challenging.
  • Hemodynamic exercise testing is a potential diagnostic tool for AS.
  • Limited understanding of exercise hemodynamics in AS patients.

Purpose of the Study:

  • To investigate exercise hemodynamics in patients with moderate AS and preserved left ventricular ejection fraction (LVEF).
  • To evaluate changes in aortic valve area (AVA), mean gradient, stroke volume (SV), and filling pressures during exercise.

Main Methods:

  • Retrospective review of 34 adults with moderate AS and preserved LVEF.
  • Invasive hemodynamics were measured during supine cycle exercise.
  • Simultaneous measurement of aortic and left ventricular pressures.

Main Results:

  • Symptomatic patients showed small increases in mean gradient and AVA during exercise.
  • No significant increase in stroke volume was observed during exercise.
  • Elevated pulmonary artery wedge pressure was prevalent at rest and during exercise.

Conclusions:

  • Symptomatic patients with moderate AS and preserved LVEF have limited SV response to exercise.
  • AVA increases during exercise in most patients.
  • Exercise commonly induces elevated filling pressures in this population.