Pressure-flow responses to exercise in aortic stenosis, mitral regurgitation and diastolic dysfunction.

Content Provider	Europe PMC
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
Copyright Year	2022
Abstract	BackgroundHaemodynamic 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 resultsOne 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).ConclusionThe 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 numbersNCT01974557, NCT01046838, NCT02961647 and NCT02395107.
Related Links	https://europepmc.org/backend/ptpmcrender.fcgi?accid=PMC9664118&blobtype=pdf
ISSN	13556037
Journal	Heart
Volume Number	108
DOI	10.1136/heartjnl-2022-321204
PubMed Central reference number	PMC9664118
Issue Number	23
PubMed reference number	36356959
e-ISSN	1468201X
Language	English
Publisher	BMJ Publishing Group
Publisher Date	2022-11-10
Publisher Place	BMA House, Tavistock Square, London, WC1H 9JR
Access Restriction	Open
Rights License	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/. © 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.
Subject Keyword	Mitral regurgitation Aortic stenosis Myocardial Infarction Heart Failure, Diastolic
Content Type	Text
Resource Type	Article
Subject	Cardiology and Cardiovascular Medicine