Predictors of exercise capacity and symptoms in severe aortic stenosis.
OBJECTIVE
This study investigated the association between invasive and non-invasive estimates of left ventricular (LV) filling pressure and exercise capacity, in order to find new potential candidates for risk markers in severe aortic valve stenosis (AS).


RESULTS
Twenty-nine patients with AS, aortic valve area (AVA) < 1 cm(2), performed a symptom-limited multistage supine bicycle exercise test. Immediately before the exercise test, the pulmonary capillary wedge pressure (PCWP), Doppler index for LV filling (E/e'), and left atrial (LA) volume were measured. Symptomatic status was determined by senior staff doctors blinded to the results of this study. All patients terminated the exercise test because of dyspnoea. There were no significant differences in AVA between asymptomatic patients (n = 9) and symptomatic patients (n = 20), and AVA did not correlate with exercise capacity (r = -0.16, P = NS). In contrast, PCWP, LA volume, and E/e' were significantly increased in the symptomatic group and they all correlated with exercise capacity (r = -0.66, -0.75, and -0.62, respectively, P < 0.001). Receiver operating characteristic curve analysis confirmed that PCWP, LA volume index, and E/e' all provided incremental information [area under the curve (AUC) = 0.90, 0.92, and 0.90, respectively, P < 0.05] over AVA index (AUC = 0.66, NS) in predicting symptomatic status.


CONCLUSIONS
PCWP, LA volume, or E/e' is closely related to exercise capacity and symptomatic status, and may therefore be important markers of disease severity in AS. Clinical Trials.gov Identifier: NCT00252317 (http://clinicaltrials.gov/ct2/results?term=NCT00252317).
Department of Cardiology B2142, Rigshospitalet, Copenhagen University Hospital, DK-2100 Copenhagen Ø, Denmark. morten.dalsgaard@rh.regionh.dk
Morten
M
Dalsgaard
Jesper
J
Kjaergaard
Redi
R
Pecini
Kasper Karmark
KK
Iversen
Lars
L
Kober
Jacob Eifer
JE
Moller
Peer
P
Grande
Peter
P
Clemmensen
Christian
C
Hassager
D000368:Aged; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000473:pathology*; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000473:pathology*; D001642:Bicycling / Q000502:physiology; D015415:Biomarkers; D004417:Dyspnea / Q000209:etiology; D005080:Exercise Test; D017079:Exercise Tolerance; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000473:pathology*; D006439:Hemodynamics; D006801:Humans; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D012307:Risk Factors; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D013318:Stroke Volume; D014463:Ultrasonography; D016277:Ventricular Function, Left
D015415:Biomarkers