Determinants and Prognostic Significance of Exercise Pulmonary Hypertension in Asymptomatic Severe Aortic Stenosis
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Background—: Recent studies emphasized the usefulness of exercise stress echocardiography in asymptomatic patients with aortic stenosis. Nevertheless, the additive value of exercise pulmonary hypertension (Ex-PHT) in such patients remains unexplored. We therefore aimed to identify the determinants and to test the impact on outcome of Ex-PHT in asymptomatic patients with severe aortic stenosis. Method and Results—: Asymptomatic patients with severe aortic stenosis (n=105; aortic valve area <0.6 cm 2 /m 2 ; age, 71±9 years; male, 59%) and preserved left ventricular systolic function (ejection fraction ≥55%) were prospectively submitted to exercise stress echocardiography. Resting PHT and Ex-PHT were defined as a systolic pulmonary arterial pressure >50 and >60 mm Hg, respectively. Ex-PHT was more frequent than resting PHT (55% versus 6%; P <0.0001). On multivariable logistic regression, the independent predictors of Ex-PHT were male sex (odds ratio, 4.3; P =0.002), resting systolic pulmonary arterial pressure (odds ratio, 1.16; P =0.002), exercise indexed left ventricular end-diastolic volume (odds ratio, 1.04; P =0.026), exercise e′-wave velocity (odds ratio, 1.35; P =0.047), and exercise-induced changes in indexed left atrial area (odds ratio, 1.36; P =0.006). Ex-PHT was associated with reduced cardiac event-free survival (at 3 years, 22±7% versus 55±9%; P =0.014). In a multivariable Cox proportional hazards model, Ex-PHT was identified as an independent predictor of cardiac events (hazard ratio, 1.8; 95% confidence interval, 1.0–3.3; P =0.047). When exercise-induced changes in mean aortic pressure gradient were added to the multivariable model, Ex-PHT remained independently associated with reduced cardiac event-free survival (hazard ratio, 2.0; 95% confidence interval, 1.1–3.6; P =0.025). Conclusions—: In asymptomatic patients with severe aortic stenosis, the main determinants of Ex-PHT are male sex, resting systolic pulmonary arterial pressure, and exercise parameters of diastolic burden. Moreover, Ex-PHT is associated with a 2-fold increased risk of cardiac events. These results strongly support the use of exercise stress echocardiography in asymptomatic aortic stenosis.
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In advanced AS, increased LV filling pressures lead to secondary pulmonary hypertension and dyspnoea.
“In the more advanced stages of the disease, the increased LV filling pressures lead to secondary pulmonary hypertension and dyspnoea symptoms126;127.”
From Calcific aortic stenosis (2016) · cites this paper as [127]
The “Exercise PHT in AS” section (p. 9) explains that increased LV filling pressure can be transmitted to the pulmonary circulation and trigger exercise pulmonary hypertension. The study concerns asymptomatic patients and does not establish that this mechanism causes dyspnoea symptoms in advanced AS. (LLM, conf=0.86)
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- Authors
- Lancellotti, P., Magne, J., Donal, E., O'Connor, K., Dulgheru, R., Rosca, M., & Pierard, L. A.
- Affiliations
- Inserm (FR)
- From the University of Liège, Department of Cardiology and GIGA Cardiovascular Sciences, University Hospital, Sart Tilman, Liège, Belgium (P.L., J.M., K.O., R.D., M.R., L.A.P.), and Cardiology Department, CIC-IT 804, LTSI INSERM U 642, Pontchaillou University Medical Center, Rennes, France (E.D.).
- Venue
- Circulation
- Published
- 2012-08-14
- Volume
- 126
- Issue
- 7
- Pages
- 851-859
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- OpenAlex
- W2008576197
- Cited by
- 216
- References
- 35
- Citations by year
- 2026: 8 · 2025: 11 · 2024: 8 · 2023: 12 · 2022: 14 · 2021: 17 · 2020: 10 · 2019: 20 · 2018: 17 · 2017: 26 · 2016: 20 · 2015: 19 · 2014: 14 · 2013: 17 · 2012: 1
- FWCI
- 10.50
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- HAL (submittedVersion, other-oa)
- ORBi (University of Liège) (submittedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Valve Diseases and Treatments
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Pulmonary Hypertension Research and Treatments
- Keywords
- exercise pulmonary hypertension, severe aortic stenosis, asymptomatic aortic stenosis, exercise echocardiography, prognostic factors, cardiac event-free survival, left ventricular end-diastolic volume, E-wave velocity, left atrial area, aortic pressure gradient, male sex, preserved left ventricular systolic function, left ventricular outflow tract obstruction
- MeSH terms
- Aged, Aged, 80 and over, Aortic Valve Stenosis, Exercise Test, Female, Heart Ventricles, Humans, Hypertension, Pulmonary, Male, Middle Aged, Prognosis, Pulmonary Wedge Pressure, Severity of Illness Index, Sex Factors, Stroke Volume, Echocardiography, Stress, Arterial Pressure
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