title: Left ventricular regional function and maximal exercise capacity in aortic stenosis.
abstract: OBJECTIVE
  The objective assessment of maximal exercise capacity (MEC) using peak oxygen consumption (VO2) measurement may be helpful in the management of asymptomatic aortic stenosis (AS) patients. However, the relationship between left ventricular (LV) function and MEC has been relatively unexplored. We aimed to identify which echocardiographic parameters of LV systolic function can predict MEC in asymptomatic AS.
  
  
  RESULTS
  Asymptomatic patients with moderate to severe AS (n = 44, aortic valve area <1.5 cm(2), 66 ± 13 years, 75% of men) and preserved LV ejection fraction (LVEF > 50%) were prospectively referred for resting echocardiography and cardiopulmonary exercise test. LV longitudinal strain (LS) of each myocardial segment was measured by speckle tracking echocardiography (STE) from the apical (aLS) 4-, 2-, and 3-chamber views. An average value of the LS of the analysable segments was provided for each myocardial region: basal (bLS), mid (mLS), and aLS. LV circumferential and radial strains were measured from short-axis views. Peak VO2 was 20.1 ± 5.8 mL/kg/min (median 20.7 mL/kg/min; range 7.2-32.3 mL/kg/min). According to the median of peak VO2, patients with reduced MEC were significantly older (P < 0.001) and more frequently females (P = 0.05). There were significant correlations between peak VO2 and age (r = -0.44), LV end-diastolic volume (r = 0.35), LV stroke volume (r = 0.37), indexed stroke volume (r = 0.32), and E/e' ratio (r = -0.37, all P < 0.04). Parameters of AS severity and LVEF did not correlate with peak VO2 (P = NS for all). Among LV deformation parameters, bLS and mLS were significantly associated with peakVO2 (r = 0.43, P = 0.005, and r = 0.32, P = 0.04, respectively). With multivariable analysis, female gender (β = 4.9; P = 0.008) and bLS (β = 0.50; P = 0.03) were the only independent determinants (r(2) = 0.423) of peak VO2.
  
  
  CONCLUSIONS
  In asymptomatic AS, impaired LV myocardial longitudinal function determines reduced MEC. Basal LS was the only parameter of LV regional function independently associated with MEC.
authors.affiliation: University of Liege Hospital, GIGA-Cardiovascular Sciences, Heart Valve Clinic, Liege, Belgium Department of Cardiology and Radiology, University Hospital Sart-Tilman, Liege 4000, Belgium.
authors.forename: R
authors.initials: R
authors.lastname: Dulgheru
authors.affiliation: University of Liege Hospital, GIGA-Cardiovascular Sciences, Heart Valve Clinic, Liege, Belgium CHU Limoges, Hôpital Dupuytren, Service Cardiologie, Limoges F-87042, France Faculté de médecine de Limoges, INSERM 1094, 2, rue Marcland, 87000 Limoges, France.
authors.forename: J
authors.initials: J
authors.lastname: Magne
authors.affiliation: University of Liege Hospital, GIGA-Cardiovascular Sciences, Heart Valve Clinic, Liege, Belgium Department of Cardiology and Radiology, University Hospital Sart-Tilman, Liege 4000, Belgium.
authors.forename: L
authors.initials: L
authors.lastname: Davin
authors.affiliation: University of Liege Hospital, GIGA-Cardiovascular Sciences, Heart Valve Clinic, Liege, Belgium Department of Cardiology and Radiology, University Hospital Sart-Tilman, Liege 4000, Belgium.
authors.forename: A
authors.initials: A
authors.lastname: Nchimi
authors.affiliation: GIGA-Cardiovascular Sciences, Human Genetics Unit, Laboratory of Thrombosis and Hemostasis, University of Liège, Liège, Belgium.
authors.forename: C
authors.initials: C
authors.lastname: Oury
authors.affiliation: University of Liege Hospital, GIGA-Cardiovascular Sciences, Heart Valve Clinic, Liege, Belgium Department of Cardiology and Radiology, University Hospital Sart-Tilman, Liege 4000, Belgium.
authors.forename: L A
authors.initials: LA
authors.lastname: Pierard
authors.affiliation: University of Liege Hospital, GIGA-Cardiovascular Sciences, Heart Valve Clinic, Liege, Belgium Department of Cardiology and Radiology, University Hospital Sart-Tilman, Liege 4000, Belgium GVM Care and Research, E.S. Health Science Foundation, Lugo (RA), Italy plancellotti@chu.ulg.ac.be.
authors.forename: P
authors.initials: P
authors.lastname: Lancellotti
mesh_terms: D000368:Aged; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D004452:Echocardiography / Q000379:methods*; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D010101:Oxygen Consumption / Q000502:physiology; D011446:Prospective Studies; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000503:physiopathology*
keywords: aortic stenosis; cardiopulmonary test; functional capacity; longitudinal strain